Abstract
On the basis of several hundreds of urodynamic investigations done in 105 SCI patients the phenomenon of urethral sphincter dyssynergia was studied.
In Upper Motor Neuron Lesion (UMNL) patients, dyssynergic contractions of the external urethral sphincter during spontaneous bladder contractions were demonstrated in 86% and, during bladder contractions initiated by suprapubic tapping, also in 86%. CREDÉ manoeuvre or abdominal straining gave an augmentation of the urethral sphincter activity in 53%. Interrupted tapping could lower a dyssynergic sphincter activity in a great number of UMNL patients. This technique of bladder stimulation was important to acquire a balanced bladder function in 28% of the patients.
In patients with a non-contracting detrusor, a non-relaxing sphincter or augmentation of the sphincter spasticity with the crédé manoeuvre or abdominal straining was found in at least 50%. The values of different forms of conservative treatment and of sphincterotomy are discussed. The final outcome of the bladder reeducation is given.
Similar content being viewed by others
Article PDF
References
Blaivas J G, Barbalias G A 1984 Detrusor external sphincter dyssynergia in men with M.S.: an ominous urologic condition. Journal of Urology 131: 91–94.
Buczynski A 1984 Urodynamic studies in evaluating detrusor sphincter dyssynergia and their effect on the treatment. Paraplegia 22: 168–172.
Diokno A, Koff S, Bender L 1974 Periurethral striated muscle activity in neurogenic bladder dysfunction. Journal of Urology 112: 743–749.
Koyanagi T, Arikado K, Takamatsu T, Tsuji T 1982 Experience with electromyography of the external urethral sphincter in Spinal Cord Injury patients. Journal of Urology 127: 272–276.
Krane R, Siroky M 1979 Clinical Neuro-Urology, Little Brown and Cie, Boston, p. 151-153.
Leyson J, Martin B, Spores A 1980 Baclofen in the treatment of detrusor sphincter dyssynergia in spinal cord injury patients. Journal of Urology 124: 82–84.
Madersbacher H 1976 The twelve o'clock sphincterotomy: technique, indications, results. Paraplegia 13: 261–267.
Mayo M, Kiviat M 1980 Increased residual urine in patients with bladder neuropathy secondary to suprasacral spinal cord lesions. Journal of Urology 123: 726–728.
McGuire E J 1984 Clinical evaluation and treatment of neurogenic vesical dysfunction. Williams and Wilkens, Baltimore, p. 69.
Perkash I 1978 Detrusor-sphincter dyssynergia and dyssynergic responses: recognition and rationale for early modified transurethral sphincterotomy in complete spinal cord injury lesions. Journal of Urology 120:469:474.
Rossier A, Fam B 1979 From intermittent catheterisation to catheter freedom via urodynamics: a tribute to Sir Ludwig Guttman. Paraplegia 17: 73–85.
Rossier A, Fam B, Lee I, Sarkarati M, Evans D 1983 The respective contribution of smooth and striated components in the urethral pressure profile of the spinal cord injured. A neuro-pharmacological and urodynamic study. Paraplegia 21: 114–116.
Siroky M, Krane R 1982 Neurological aspects of detrusor-sphincter dyssynergia, with reference to the guarding reflex. Journal of Urology 127: 953–957.
Wein A 1982 Editorial comment. Journal of Urology 127: 276.
Wyndaele J J 1984 A critical review of urodynamic investigations in spinal cord injury patients. Paraplegia 22: 22.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wyndaele, J. Urethral sphincter dyssynergia in spinal cord injury patients. Spinal Cord 25, 10–15 (1987). https://doi.org/10.1038/sc.1987.5
Issue Date:
DOI: https://doi.org/10.1038/sc.1987.5