Management of the Detrusor Sphincter Dyssynergia

Detrusor sphincter dyssynergia(DSD) is a disturbance of the normal synergistic coordination between bladder contraction and external urethral sphincter muscles relaxationduring voiding. In patients with neurogenic bladder, the urethral sphinctermuscle contracts during voiding instead of completely relaxing. This results in alteration of the normal flow and rising of the bladder pressure. The voiding dysfunction and the subsequent dysfunction of the emptying phase of micturition represent a high risk of complications for patients with neurogenic bladder, in relation with high intra-vesical pressure and lack of complete bladder emptying such as: lithiasis, urinary tract infection (UTI), vesico-ureteral reflux, hydronephrosis, and renal failure. Therefore, management of DSD requires a multidisciplinary and careful follow-up to prevent complications. Various physicians should be involved including surgeon, rehabilitation physician, neurologist. Treatment of DSD is a moving field with new emerging approaches and therapies such as botulinum toxin, urethral stent, and promising pharmacological treatment. Therapeutics are often highly specific and should be individually tailored, but with always the same aim: to prevent complications which can impact quality of life, and life expectancy of patients. Here we propose a therapeutic approach to DSD, based on a review of the recent literature and our personal experience. At the end, we try to summarize recommendations for managing DSD in neurogenic bladder.