dyssynergi

Dyssynergia, in urology often called detrusor-sphincter dyssynergia (DSD), is a discoordination between detrusor contraction and external urethral sphincter relaxation during voiding. It is commonly seen in neurogenic conditions affecting the micturition reflex, such as spinal cord injury, multiple sclerosis, stroke, or brain malformations, and may occur as part of a neurogenic bladder syndrome.

Normally, the detrusor muscle contracts while the external sphincter relaxes under control of the pontine micturition center. Lesions above or within the spinal cord can produce paradoxical sphincter contraction or failure to relax during voiding, generating increased voiding pressures (detrusor– sphincter dyssynergia) and reduced urine flow with residual urine.

Patients may report hesitancy, straining, weak or intermittently interrupted urine stream, and bladder distention. Diagnosis relies on urodynamic testing showing detrusor contraction concurrent with sphincter EMG activity or incomplete sphincter relaxation, often with high voiding pressures. Imaging and neurophysiologic assessment help define underlying lesions.

Management combines behavioral measures (timed voiding, double voiding, pelvic floor biofeedback) and pharmacologic therapy (alpha-blockers to ease outlet resistance; anticholinergics or beta-3 agonists for detrusor overactivity). Botulinum toxin injections into the external sphincter or detrusor, sacral neuromodulation, and, in selected cases, sphincterotomy or other surgical interventions may be used. Intermittent catheterization is often employed to ensure complete emptying.

Prognosis depends on the underlying neurological condition and adherence to treatment; long-term risks include urinary tract infections or renal complications if voiding remains obstructed.