Detrusor-external Sphincter Dyssynergia Research Articles

Bladder outlet obstruction in women: Scope of the problem and differential diagnosis

AbstractIntroductionThe prevalence, formal definition, and diagnostic criteria of bladder outlet obstruction in owmen have not been clearly defined.MethodsThis is a literature review of the definition of BOO in women, its prevalence, as well as its differential diagnosis.ResultsThe main causes of BOO in women are divided into functional and anatomic conditions. Functional etiologies include detrusor external sphincter dyssynergia, dysfunctional voiding, Fowler's syndrome, and primary bladder neck obstruction. Anatomic causes can be further divided into extrinsinc and intrinsic conditions. Intrinsic etiologies include urethral stricture and urethral diverticula, whereas extrinsic causes comprise pelvic organ prolapse, post anti‐incontinence surgery, and Skene's gland cyst or abscess.ConclusionsThere are multiple etiologies to BOO in women, and this condition is most probably underdiagnosed, owing to a lack of consensus for a standard definition.

Video-urodynamics efficacy of sacral neuromodulation for neurogenic bladder guided by three-dimensional imaging CT and C-arm fluoroscopy: a single-center prospective study

To assess the efficacy of sacral neuromodulation (SNM) for neurogenic bladder (NB), guided by intraoperative three-dimensional imaging of sacral computed tomography (CT) and mobile C-arm fluoroscopy through video-urodynamics examination. We enrolled 52 patients with NB who underwent conservative treatment with poor results between September 2019 and June 2021 and prospectively underwent SNM guided by intraoperative three-dimensional imaging of sacral CT and mobile C-arm fluoroscopy. Video-urodynamics examination, voiding diary, quality of life questionnaire, overactive bladder symptom scale (OABSS) scoring, and bowel dysfunction exam were completed and recorded at baseline, at SNM testing, and at 6-month follow-up phases. Finally, we calculated the conversion rate from period I to period II, as well as the treatment efficiency and the occurrence of adverse events during the testing and follow-up phases. The testing phase of 52 NB patients was 18–60 days, with an average of (29.3 ± 8.0) days. Overall, 38 patients underwent SNM permanent electrode implantation, whose follow-up phase was 3–25 months, with an average of (11.9 ± 6.1) months. Compared with baseline, the voiding times, daily catheterization volume, quality of life score, OABSS score, bowel dysfunction score, maximum detrusor pressure before voiding, and residual urine volume decreased significantly in the testing phase. The daily voiding volume, functional bladder capacity, maximum urine flow rate, bladder compliance, and maximum cystometric capacity increased significantly in the testing phase. Besides, the voiding times, daily catheterization volume, quality of life score, OABSS score, bowel dysfunction score, maximum detrusor pressure before voiding, and residual urine volume decreased further from the testing to follow-up phase. Daily voiding volume, functional bladder capacity, maximum urine flow rate, bladder compliance, and maximum cystometric capacity increased further from testing to follow-up. At baseline, 10 ureteral units had vesicoureteral reflux (VUR), and 9 of them improved in the testing phase. Besides, there was 1 unit that further improved to no reflux during the follow-up phase. At baseline, 10 patients had detrusor overactivity (DO), and 8 of them improved in the testing phase. Besides, 1 patient’s symptoms further improved during the follow-up phase. At baseline, there were 35 patients with detrusor-bladder neck dyssynergia (DBND); 14 (40.0%) of them disappeared during the testing phase. Among 13 cases who had DBND in the testing phase, 6 (46.2%) disappeared during the follow-up phase. Of the 47 patients with detrusor-external sphincter dyssynergia (DESD) at baseline, 8 (17.0%) disappeared during the testing phase. Among 26 cases who had DESD in the testing phase, 6 (23.1%) disappeared during the follow-up phase. The effective rate of this study was 88.5% (46/52), and the conversion rate from phase I to phase II was 73.1% (38/52). Additionally, the efficacy in a short-term follow-up was stable. SNM guided by intraoperative three-dimensional imaging of sacral CT and mobile C-arm fluoroscopy is an effective and safe treatment option for NB in short time follow-up. It would be well improved in the bladder storage function, sphincter synergetic function and emptying efficiency by video-urodynamics examination in this study.Trial registration: Chinese Clinical Trial Registry. ChiCTR2100050290. Registered August 25 2021. http://www.chictr.org.cn/index.aspx.

Conforming an Extracorporeal Lithotripter System for Video Urodynamic Studies

Objectives: This study aimed to evaluate the efficiency using existing fluoroscopic unit and lithotripter table of an extracorporeal lithotripter system for video urodynamic studies (VUDS) to determine anatomical abnormalities in patients with neurogenic lower urinary tract dysfunction (NLUTD).
 Methods: The extracorporeal lithotripsy system was adapted to obtain optimum fluoroscopic view according to body shape and observed organs of patients. We reviewed the VUDS data of 25 patients with NLUTD.
 Results: “Christmas tree bladder” (CTB) was found in 5 (20%) patients. Vesicoureteral reflux (VUR) and external detrusor sphincter dyssynergia (DESD) were detected in 3 (12%) and 4 (16%) patients, respectively. Four (16%) patients with normal coordination between detrusor contraction and external sphincter relaxation were proven by VUDS. CTB, VUR, or DESD was not observed in 10 (40%) patients with flaccid bladder. Hematuria, urinary tract infection, or autonomic dysreflexia did not occur in any of the patients.
 Conclusions: VUDS can discern anatomical abnormalities of the urinary tract, and patients in undeveloped areas of the world who have NLUTD can have easier access to VUDS because of the decreasing capital cost of VUDS.

Urodynamic findings in patients with complete and incomplete suprasacral spinal cord injury at different stages after injury.

Urodynamics is the gold standard for evaluating the function of neurogenic bladder after spinal cord injury (SCI), but there are few studies on urodynamics in patients with complete and incomplete suprasacral SCI in different periods.There is a lack of sufficient evidence for the timing of the first urodynamic examination. The urodynamic results of 101 patients with complete and incomplete suprasacral SCI at 0-30, 31-60, 61-90, and 91-365 days after injury were included. Urodynamic parameters were compared between 0-90 and 91-365 days, including detrusor overactivity (DO), bladder compliance (BC), bladder-filling sensation, maximum cystometric capacity (MCC), detrusor external sphincter dyssynergia (DESD), maximum urinary flow rate (Qmax), detrusor pressure at a maximum urinary flow rate (PdetQmax). There were 45 patients with complete SCI and 56 with incomplete SCI. With the course's prolongation, the proportion of DO increased gradually in patients with complete and incomplete injury within 90 days, while the MCC gradually decreased. The bladder-filling sensation of patients with complete SCI is mostly absent. Significant differences were found between 0-90 and 91-365 days in terms of DO, DESD, MCC, Qmax, and PdetQmax incomplete SCI, and DESD in incomplete SCI, and between complete and incomplete SCI in terms of DO, bladder filling sensation, MCC, Qmax, PdetQmax at 0-90 days after injury, and bladder filling sensation at 91-365 days after injury. Urodynamic examination should be conducted as soon as possible after injury in patients with incomplete suprasacral SCI, while for those with complete injury, the urodynamic examination can be initiated following clinical symptoms within 90 days after injury.

Combined Detrusor and External Urethral Sphincter BTX-A Injections for Detrusor Overactivity and Detrusor External Sphincter Dyssynergia Secondary to Spinal Cord Injury

Objective: To evaluate the efficacy and safety of Combined detrusor and external urethral sphincter BTX-A injections for detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) secondary to spinal cord injury. Study Design: Prospective study. Methods: The study was carried out in 18 SCI patients with detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) receiving Combined detrusor and external urethral sphincter BTX-A injections treatment. Contain 200 U botulinum toxin intradetrusor and 100 U external urethral sphincter injections. The effective outcomes included maximum detrusor pressure at first DO and DESD (PdetmaxDO-DESD), volume at first DO and DESD (VDO-DESD), maximum urethral closure pressure (MUCP), and Incontinence-Specific Quality-of-Life Instrument (I-QoL). Adverse events were recorded. Results: All patients experienced a significant mean reduction in PdetmaxDO-DESD (50.75%), maximum urethral closure pressure (26.34%) and a significant mean increase in VDO-DESD (63.00%) 12-weeks post-injection. Significant (p < 0.001) improvement in mean Incontinence-Specific Quality-of-Life Instrument was also found. No obvious adverse event and toxic effect was observed. Conclusion: Combined detrusor and external urethral sphincter BTX-A injections is a good choice for patients with DO and DESD secondary to spinal cord injury. It could not only protect the upper urinary tract but also improve quality of life.

Low Interrater Reliability of Videourodynamic Diagnosis of Detrusor External Sphincter Dyssynergia.

Complex bladder dysfunction requires urodynamic testing, often under fluoroscopy termed videourodynamic study (VUDS), to assist the diagnosis and management. Videourodynamic study is an objective tool with high interrater reliability (IRR) for identifying detrusor overactivity. However, IRR has not been validated with disorders associated with neurogenic bladder (NGB). We aim to investigate the IRR of VUDS to diagnose detrusor external sphincter dyssynergia (DESD) among NGB patients and hypothesize a high IRR to DESD diagnosis on VUDS. Videourodynamics tracings with fluoroscopic images were rated either positive or negative for evidence of DESD by 4 raters (2 neurourologists, neurourology fellow, and urology postgraduate year 2 resident), in patients who underwent VUDS from 2013 to 2017. The study population had known NGB without previous bladder reconstruction. The IRR was determined using percent agreement and κ values. The experts had a percent agreement of 82.1% (κ = 0.26). Expert 1 and expert 2 had a percent agreement of 63.6% (κ = 0.1497) and 68.9% (κ = 0.2967), respectively, when compared with the fellow. Sensitivity and specificity ranged from 28% to 75% and 64% to 93%, respectively. The negative predictive values ranged from 90% to 95%. The IRR to diagnose DESD on VUDS was much lower than expected, even among experts, and was likely multifactorial and partially owing to lack of clinical context and lack of standardized VUDS interpretation of the electromyogram. A high negative predictive value was found among all participants. Further research is needed to evaluate factors contributing to the low reproducibility of DESD diagnosis on VUDS.

PD04-11 LONG TERM URODYNAMIC RESULTS FOLLOWING EXTERNAL SPHINCTEROTOMY IN SPINAL CORD INJURY PATIENTS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction I1 Apr 2018PD04-11 LONG TERM URODYNAMIC RESULTS FOLLOWING EXTERNAL SPHINCTEROTOMY IN SPINAL CORD INJURY PATIENTS Andrew Margules, Lawrence Lee, Whitney Smith, Mihir Shah, Alana Murphy, Akhil Das, and Patrick Shenot Andrew MargulesAndrew Margules More articles by this author , Lawrence LeeLawrence Lee More articles by this author , Whitney SmithWhitney Smith More articles by this author , Mihir ShahMihir Shah More articles by this author , Alana MurphyAlana Murphy More articles by this author , Akhil DasAkhil Das More articles by this author , and Patrick ShenotPatrick Shenot More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.289AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES External sphincterotomy is a commonly employed to allow safe, simple urologic management of spinal cord injured (SCI) males. Long-term outcome data following external sphincterotomy is limited. We evaluated the long-term results of primary external sphincterotomy using urodynamic and clinical endpoints. METHODS Ninety seven SCI (85 quadriplegic, 12 paraplegic) male patients with Neurogenic detrusor overactivity (NDO) and detrusor-external sphincter dyssynergia (DESD) underwent Nd:Yag laser sphincterotomy between 1992 and 2000. 73 patients (mean age 27.6 years) with yearly follow-up urodynamic studies of at least 5 years were included in this study. Mean clinical and urodynamic follow-up is 14.8 years. RESULTS Voiding pressure remained <50 cm H2O in 84 % (57/73), 81% (27/36) %, and 80% (23/29) of patients at 5, 10, and 15 years respectively. Post-void residual (PVR) begins to significantly increase approximately five years following spincterotomy without an associated increase in voiding pressure. Recurrent sphincter obstruction was seen in 10% (7/73) patients prompting repeat sphincterotomy. Clinical and urodynamic findings suggestive of impaired detrusor contractility was noted in 21% (15/73), 33% (12/36), and 59% (17/29) of patients at 5, 10 and 15 years following initial sphincterotomy. In addition, 41 % (30/73) were on either intermittent catheterization, or had an indwelling catheter. Hydronephrosis was present in 7% (5/73) patients at the time of the initial procedure and resolved after sphincterotomy. No patient developed recurrent hydronephrosis during the follow-up period. CONCLUSIONS Although voiding pressures and upper tracts remains stable following laser external sphincterotomy, PVR is seen to steadily increase beginning approximately five years following the procedure indicating a trend toward impaired detrusor contractility that accounts for the majority of failures. Patients should be counseled that external sphincterotomy is associated with significant long term failure rates. Further studies are needed to define the natural history of bladder dysfunction in SCI to determine whether this finding of progressive detrusor underactivity occurs in untreated patients who reflexively void. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e81-e82 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andrew Margules More articles by this author Lawrence Lee More articles by this author Whitney Smith More articles by this author Mihir Shah More articles by this author Alana Murphy More articles by this author Akhil Das More articles by this author Patrick Shenot More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urodynamic Abnormalities in Patients with Relapsing Remitting Multiple Sclerosis

Background: Multiple sclerosis (MS) is a disease with wide variability in clinical presentation. Bladder dysfunctions are very common in MS patients. Early detection of bladder abnormalities is important to improve the outcome in MS patients. Objectives: The aim of this study is to evaluate the urodynamic detected bladder dysfunctions in relapsing remitting MS patients with mild or without lower urinary tract symptoms. Methods: This is a prospective study for 32 patients with relapsing remitting Multiple Sclerosis from January 2017 to June 2018. We included patients with mild or without lower urinary tract symptoms (LUTS) who had mild to moderate disability. Urodynamic studies were performed for all patients. Results: Urodynamic abnormalities were detected in 22 patients (68.75%). Detrusor overactivity (DO) was present alone in 8 patients (25%); DO combined with detrusor external sphincter dyssynergia in 8 patients (25%); DO with low compliant bladder and impaired contractility in another 4 patients (13%) while DO with low complaint bladder in 2 patients (6%). Bladder dysfunction was correlated to high disability score; longer duration of illness; frequent relapses and the presence of LUTS. Conclusion: Urodynamic abnormalities were found in 68.75% of our patients. This highlights the importance of urodynamic studies in the early evaluation of relapsing remitting Multiple Sclerosis.

Multiscale Entropy Analysis of Surface Electromyographic Signals from the Urethral Sphincter as a Prognostic Indicator for Surgical Candidates with Primary Bladder Neck Obstruction

To explore information hidden in the electromyographic (EMG) signals of the urethral sphincter that may be of prognostic significance for patients with primary bladder neck obstruction (PBNO), 41 patients with voiding difficulty were divided into four groups: 1) patients with primary bladder neck obstruction (PBNO) with successful (Group 1, n = 14) and 2) unsuccessful (Group 2, n = 8) surgical outcomes, 3) patients with detrusor overactivity (Group 3, n = 7), and 4) patients with detrusor-external sphincter dyssynergia (Group 4, n = 12). All patients underwent baseline urodynamic studies (preoperative for Group 1 and Group 2) for comparison. The results demonstrated that, despite no significant difference in urodynamic parameters between Group 1 and Group 2, the large-scale multiscale entropy (MSE) of preoperative EMG (i.e., MSELS(EMG)) of Group 1 was significantly higher than that of Group 2 without notable difference between Group 1 and Group 3 (i.e., patients with normal sphincter function). Moreover, the MSELS(EMG) and small-scale MSE of preoperative EMG (i.e., MSESS(EMG)) of Group 2 were notably higher than those of Group 4 (i.e., patients with abnormal sphincter function), while both MSELS(EMG) and MSESS(EMG) of Group 3 were notably higher than those of Group 2. In conclusion, using MSE analysis for assessing preoperative urethral sphincter EMG signals successfully distinguished between PBNO patients with subsequent successful surgery from those with surgical failure possibly due to subtle functional impairment of the urethral sphincter that cannot be detected by routine urodynamic studies. The results, therefore, highlight the potential clinical significance of this analytical tool in guiding urologists regarding their choice of medical versus surgical treatment for this patient population.

Risk factors to develop autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury.

The risk factors for developing autonomic dysreflexia (AD) during urodynamic (UD) examination in patients with spinal cord injury (SCI) above Th6 still remain unclear. The main goal of our study is to investigate the risk factors that could be associated with AD in these particular patients. Cross sectional survey. The study was carried out in 83 patients with SCI above Th6 who were submitted to our center for a UD examination. AD was defined as a rise in systolic blood pressure above 15 mm Hg with a pulse rate below 60 beats per minute. The prevalence rate of AD among our patients was 54%. Univariate analysis of our study showed the following risk factors: patient's age, SCI completeness, traumatic etiology, indwelling catheter, presence of chills or sweating, anticholinergic treatment, maximum detrusor voiding pressure, detrusor pressure at maximum flow rate, detrusor external sphincter dyssynergia, and bladder outlet obstruction. Using multivariate logistic regression, we found that there are only two independent risk factors: patient's age equal to or above 45 years of age (OR = 10.995) and maximum detrusor voiding pressure equal to or above 31 cm H2 O (OR = 3.879). According to our results, the patient's age and maximum detrusor voiding pressure should be considered at the time of performing a UD examination in order to prevent the sudden onset of AD in patients with SCI above Th6. Neurourol. Urodynam. 36:171-175, 2017. © 2015 Wiley Periodicals, Inc.

Bladder dysfunction in chikungunya: Experience of the academic hospital of Fort de France in Martinique (France)

Chikungunya is an arbovirus transmitted by Aedes mosquitoes. Significant epidemics have been reported in Reunion in 2005–2006 and the French West Indies whose Martinique in 2013-2014. Mainly, Chikungunya is characterized by polyarthralgia and fever. Patients also related overactive or hypoactive bladder. Those bladder dysfunctions have been described in literature just one time by an Indian team [1] in 2006–2007. The purpose of this study is to identify and describe these disorders. Patients were enrolled using a screening urinary disorders questionnaire through Chikungunya consultation in academic hospital of Fort-de France from January 2015. Recruitment of 51 patients: urinary urgency (58%), nocturia (66%), stress urinary incontinence (45%), daytime urinary frequency (15%), enuresis (7%), dysuria (27%). Urodynamic studies show overactive detrusor (57%) with and without detrusor-external sphincter dyssynergia (42%), or intrinsic sphincter deficiency (42%). Dysuria (42%) at flow determination. Bladder dysfunctions in acute Chikungunya are frequent, and may become chronical. Hypothesis concerning aetiology are myelopathy or neuropathy. Evolution of symptoms is uncertain. A study evaluating the follow up of those patients is still going on.

Urologic applications of botulinum toxin.

The neuromuscular blocker botulinum toxin has a wide variety of medical applications, including overactive bladder and neurogenic detrusor overactivity in patients in whom drug therapy fails or is not well tolerated. Botulinum toxin therapy for these conditions has been shown to be safe and effective in several large multicenter randomized controlled trials. Off-label uses in urology include detrusor external sphincter dyssynergia and pelvic pain syndromes.

Risk factors of urethral diverticula in male patients with spinal cord injury.

A case-control study in a series of 55 males with urethral diverticula (UD) and their correspondent control, matched by age and time of radiological assessments. To evaluate the risk factors to develop UD in males with spinal cord injury (SCI) and the place in the urethra where they are, most commonly, allocated. Toledo, Spain. Clinical histories and urodynamic studies, of all patients, were reviewed. The study was completed with a telephone survey according to an established protocol. The univariate analysis study showed the following risk factors: the age of onset of the spinal injury, the sphincterotomy procedure, personal history of lower urinary tract infections (LUTIs) and the chronic need of either indwelling catheter (IC) or the external condom drainage (ECD). Regarding the location of the UD, we have found the stress urinary incontinence as the only risk factor to develop UD in the prostatic urethra.On the other hand, we can conclude that the sphincterotomy, the ECD, the personal history of LUTIs and the detrusor external sphincter dyssynergia seem to be risk factors to develop diverticula in the bulbo-membranous urethra. Finally, we could point out the IC as the only risk factor for penile UD. Multivariate analysis showed that all of these risk factors were independent among them except the age of the onset of the injury and the ECD for UD in the bulbo-membranous urethra. According to our study, there is evidence of some specific risk factors for the development of UD in male patients with SCI, and therefore we should adopt the appropriate preventive measures to prevent them.

Treatment of Detrusor External Sphincter Dyssynergia Using Ultrasound-Guided Trocar Catheter Transurethral Botulinum Toxin A Injection in Men With Spinal Cord Injury

ObjectiveTo evaluate the effects of transrectal ultrasound-guided trocar catheter transurethral botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD) in men with spinal cord injury (SCI). DesignDescriptive study. SettingHospital rehabilitation department. ParticipantsPatients (N=15; mean age, 40.5y; range, 22–64y) with suprasacral SCI with confirmed DESD determined by urodynamic study. InterventionsA single dose of 100U BTX-A was injected into the EUS via transrectal ultrasound-guided trocar catheter transurethral injection. Main Outcome MeasuresMaximal detrusor pressure, detrusor leak point pressure, maximal pressure on static urethral pressure profilometry, postvoid residual volume, and maximal flow rate. ResultsAfter BTX-A transurethral injection, 4 (28.5%) patients showed an excellent result and 7 (46.7%) patients showed an improved result, whereas 4 (28.5%) patients experienced treatment failure. The overall success rate was 75.2%. We observed a significant decrease in static urethral pressure (P<.05) and detrusor leak point pressure after treatment (P<.05), but not in detrusor pressure. The postvoid residual volume were significantly decreased in the fourth week after treatment (P<.05). ConclusionsTransrectal ultrasound-guided trocar catheter transurethral BTX-A injection into the EUS effectively suppresses or ameliorates DESD. A potential advantage of the method is that ultrasound guidance may not be necessary in the next injection.

No. 55 Treatment of Detrusor External Sphincter Dyssynergia Using Ultrasound-Guided Catheter Trocar Botulinum Toxin A Injection in Male Patients with Spinal Cord Injury

PM&RVolume 6, Issue 8S2 p. S93-S94 Oral Presentation No. 55 Treatment of Detrusor External Sphincter Dyssynergia Using Ultrasound-Guided Catheter Trocar Botulinum Toxin A Injection in Male Patients with Spinal Cord Injury Wei Xin Yang, Wei Xin YangSearch for more papers by this authorHong Jun Zhu, Hong Jun ZhuSearch for more papers by this authorDa Wei Zhang, Da Wei ZhangSearch for more papers by this authorWei Guo Chen, Wei Guo ChenSearch for more papers by this author Wei Xin Yang, Wei Xin YangSearch for more papers by this authorHong Jun Zhu, Hong Jun ZhuSearch for more papers by this authorDa Wei Zhang, Da Wei ZhangSearch for more papers by this authorWei Guo Chen, Wei Guo ChenSearch for more papers by this author First published: 18 September 2014 https://doi.org/10.1016/j.pmrj.2014.08.323Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume6, Issue8S28th World Congress of the International Society of Physical & Rehabilitation Medicine (ISPRM)August 2014Pages S93-S94 RelatedInformation

Quality Assurance and Patient Safety in the Gastroenterology Unit

Neural control of the pelvic organs is one of the most intriguing in the body involving both autonomic and somatic components organized in the thoraco-lumbar (sympathetic), lumbosacral (somatic), and sacral (parasympathetic) spinal cord. Loss of supraspinal descending control and plasticity-mediated alterations at the level of the spinal cord, result in loss of voluntary control and in abnormal functioning of these systems including the development of dyssynergia and spasticity. Originally DSD has been used for Bladder external urethral sphincter discoordination, also known as detrusor external sphincter dyssynergia. The ICS standard terminology agreed in 1998, “ DSD is a consequence of a neurological pathology such as spinal cord injury or multiple sclerosis that disrupts central nervous system regulation of the Micturition (urination) reflex, resulting in discoordination of the detrusor muscles of the bladder and the external urethral sphincter muscles [1]”. Since anal external sphincter and external urethra sphincter share essentially the same innervations [2], these patients also have Ano-rectal and Pelvic floor dyssenergia (PVD) following spinal cord lesions. The terms Detrusor Sphincter Dyssenergia (DSD) and dyssenergic response indicated uncoordinated external urethral sphincter (EUS) on attempted voiding in complete and incomplete spinal cord injury lesions [1]. In normal persons attempted voiding leads to the relaxation of the external urethral sphincter; however in any supraconal spinal cord lesion below Pontine Micturition Center, there is a failure of relaxation of the urethral sphincter which leads to retention of urine. In incomplete lesions there may be some intermittent relaxation on attempted voiding which was referred as dyssenergic response [3]. This can be demonstrated on simultaneous recording of bladder pressures [Manometry] and a periurethral EMG studies.

Urodynamic characteristics and clinical interventions of neurogenic bladder following cerebrovascular accident

Objective To explore the urodynamic characteristics of neurogenic bladder caused by cerebrovascular accident and to evaluate its clinical intervention efficacy.MethodsFrom March 2007 to July 2011,40 patients with cerebrovascular accident-associated neurogenic bladder underwent a complete urodynamic study with electromyography.Their clinical data were analyzed retrospectively and the urine dynamics characteristics were summarized.Clinical interventions were given to the patients based on the urine dynamics characteristics and the clinical efficacies were observed.ResultsTwenty-three patients(57.5%) had detrusor overactivity,5(12.5%) had acontractile detrusor,36(90%) had security bladder,2(5%) had upper urinary tract dilation,and no patients had detrusor-external sphincter dyssynergia.After clinical interventions based on urodynamic characteristics,water disappeared in 1 patient with upper urinary tract dilation and reduced in the other.The quality of life(QOL) score was 3.4±1.0 at 2 weeks after clinical interentions,which was significantly lower than that before intervention (4.4±0.6,P0.01).QOL score was 2.9±0.8 at 3 months after interventions,which was significantly lower than those before and at 2 weeks after interventions(all P0.01).ConclusionDetrusor overactivity is the main urodynamic characteristic of cerebrovascular accident-associated neurogenic bladder,and detrusor-external sphincter dyssynergia,reflux and upper urinary tract dilation are rarely seen.Clinical interventions based on urodynamic characteristics can protect renal function and improve the QOL of the patients.

Video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients

To explore the video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients. Video-urodynamic examination was performed in 113 patients with complete cervical and thoracic spinal cord injury from January 2008 to May 2010. And their characteristics, managements and 3-year follow-up outcomes were reviewed and analyzed retrospectively. Among them, there were detrusor overactivity (n = 82, 72.57%), detrusor areflexia (n = 31, 27.43%), detrusor external sphincter dyssynergia (n = 71, 62.83%), low-compliance (n = 59, 52.21%), reflux (n = 6, 5.31%) and ultrasonic uronephrosis (n = 12, 10.62%). According to the result of the video-urodynamic examination, detrusor overactivity patients chose oral anticholinergic agents, botulinum toxin type A injection method, detrusor areflexia patients chose regular intermittent catheterization for bladder training. During a 3-year follow-up, there were cystic calculus (n = 2) and urinary infection (n = 7).No special complication occurred. The video-urodynamic characteristics vary in complete cervical and thoracic spinal cord injury patients. The major symptoms include detrusor overactivity, detrusor external sphincter dyssynergia and low-compliance bladder. Proper management is essential for protecting upper urinary tract and preventing urinary system complication.

The Successful and Novel Treatment of Non-Neurogenic Detrusor-External Sphincter Dyssynergia (DESD) with Botulinum Toxin A

Introduction: Our study aims to examine the treatment outcomes of patients with non-neurogenic detrusor-external sphincter dyssynergia (DESD) after the injection of botulinum toxin A (BTX-A, Botox®) to the external sphincter. Methods: A retrospective review of nine patients with DESD was performed. All patients were diagnosed with the aid of video urodynamic studies. Pre-operative evaluation was standardised using bladder diary, urine microscopy and culture, bedside ultrasound of the kidneys and bladder, and renal function test. Each received BTX-A injection of 50–100U to the external sphincter. The pre-operative and post-operative maximum flow rate (Qmax) and post-void residual urine (PVRU) were objectively compared using paired-samples t test. Results: All the injections were performed from December 2006 to March 2008. Of the nine patients, seven (77.8%) were female and two (22.2%) were male. The mean age was 49.2 years (range 20–64 years). The mean pre-operative maximum flow rate (Qmax) was 9.7±6.26 ml/s. A month later, the post-operative Qmax improved to 16.5±11.3 ml/s. Mean difference in Qmax was 6.76±8.1 ml/s ( P = 0.037). The mean preoperative post void residual urine (PVRU) was 179.2±86.8 ml. This improved to 45.7±44.4 ml post-operatively. The mean difference in PVRU of 133.6±77.2 ml ( P = 0.001). Conclusion: In patients with DESD, there is a significant improvement in PVRU and Qmax after the injection of BTX-A. Hence, BTX-A injection is an effective method of treatment for DESD. However, further studies and follow-up are required to further evaluate patient satisfaction, quality of life and need for repeated injections.

Acute Spinal Cord Injury—Do Ambulatory Patients Need Urodynamic Investigations?

We compared the urodynamic parameters of ambulatory vs nonambulatory acute spinal cord injured patients. A total of 27 women and 33 men (mean age 58 years) with neurogenic lower urinary tract dysfunction due to acute spinal cord injury (duration of injury less than 40 days) were prospectively evaluated. The patients were dichotomized according to the mobility for moderate distances subscale of the SCIM (Spinal Cord Independence Measure) version III into ambulatory (score of 3 or greater) and nonambulatory (score less than 3). Videourodynamic parameters including maximum detrusor pressure during the storage phase, bladder compliance, detrusor overactivity, detrusor external sphincter dyssynergia and vesicoureterorenal reflux were compared between the groups. Of the 60 patients with acute spinal cord injury 17 were ambulatory and 43 were nonambulatory. Mean ± SD duration of injury at urodynamic investigation was 30 ± 8 days. The lesion level was cervical in 14 patients, thoracic in 28 and lumbar/sacral in 18. Comparing unfavorable urodynamic parameters, no significant differences were found between ambulatory vs nonambulatory patients in terms of a high pressure system during the storage phase (29% vs 33%, p = 0.81), a low compliance bladder (12% vs 7%, p = 0.54), detrusor overactivity (24% vs 47%, p = 0.1), detrusor external sphincter dyssynergia (18% vs 21%, p = 0.77) and vesicoureterorenal reflux (0% vs 5%, p = 0.36). Ambulatory and nonambulatory patients with acute spinal cord injury have a similar risk of unfavorable urodynamic measures. Thus, we strongly recommend the same neurourological assessment including urodynamic investigations in all acute spinal cord injury patients independent of the ability to walk.