Bladder Detrusor Spincter Synergia

1. 1

2. Moderators:
Professors:
• Prof. Dr. G. Sivasankar, M.S., M.Ch.,
• Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
• Dr. J. Sivabalan, M.S., M.Ch.,
• Dr. R. Bhargavi, M.S., M.Ch.,
• Dr. S. Raju, M.S., M.Ch.,
• Dr. K. Muthurathinam, M.S., M.Ch.,
• Dr. D. Tamilselvan, M.S., M.Ch.,
• Dr. K. Senthilkumar, M.S., M.Ch.
Dept of Urology, GRH and KMC, Chennai. 2

3. DYSSYNERGIA:
refer to the kinesiologic dissociation of two groups
of muscles that works in harmony
SPHINCTER DYSSYNERGIA
refers to involuntary contraction or lack of
relaxation of either striated sphincter or smooth
sphincter
3
Dept of Urology, GRH and KMC, Chennai.

4. STRIATED SPHINCTER DYSSYNERGIA
*seen after complete supra spinal cord
injury following the period of spinal shock
SMOOTH SPHINCTER DYSSYNERGIA
*seen classically in autonomic
hyperreflexia
DSD unless specified refers to
Dyssynergia of striated sphincter
-abbreviated as DSD or DESD
4
Dept of Urology, GRH and KMC, Chennai.

5. CAUSES:
TRUE DESD:
exist only in pts who have an abnormality in
pathways between sacral spinal cord and brain
stem micturition centre generally caused by
neurological injury or disease
common causes are
1.Traumatic spinal cord injury
2.multiple sclerosis
3.Transverse myelitis
4. CVA
5.spinal dysraphism
6. Syringomyelia
5
Dept of Urology, GRH and KMC, Chennai.

6. TYPES:
Blaivas and co workers(1981)
3 main types
TYPE 1:
concomitant increase in both detrusor
pressure and EMG activity
at the peak of detrusor contractions , the
sphincter relaxes and unobstructed voiding
occurs
TYPE2:
Sporadic contractions of striated sphincter
throughout detrusor contraction
6
Dept of Urology, GRH and KMC, Chennai.

7. TYPE 3:
Cresento-decresento pattern of sphincter
contraction that result in outlet obstruction
throughout the entire detrusor contraction
SCHURCH &COLLEQUES(2005)
TYPE1:
Incomplete sensory & motor lesion generally
present
TYPE 2&3:
Complete sensory &motor lesion
WELD & ASSOCIATS(2000)
1.Intermittent
2.continuous: associated with complete injuries
7
Dept of Urology, GRH and KMC, Chennai.

8. PSEUDODYSSYNERGIA:
Sphincter EMG activity that increases
simultaneously with intravesical or detrusor pressure does
not always indicate true DSD
In other instances that increases are referred to us as
pseudo Dyssynergia
CAUSES:
1.Abdominal straining to initiate or augment
a bladder contraction or in response to discomfort
2.Attempted inhibition of a bladder contraction
either because of its involuntary nature or
because of discomfort
Differentiated from true DSD by urodynamically by
analyzing the patterns of detrusor and EMG activity
8
Dept of Urology, GRH and KMC, Chennai.

9. COMPLICATIONS:
50% of men develop complications without proper
treatment
1. VUR
2.Upper tract deterioration
3.Urolithiasis
4.Urosepsis
5.Ureterovesical obstruction
In women these complications are much less
-because of decreased detrusor pressure generated
9
Dept of Urology, GRH and KMC, Chennai.

10. TREATMENT
Blaivas type 1.
managed by observation unless there is
*persistent reflux
*hydronephrosis
*autonomic hyperreflexia
Type 2& 3: should be treated
AIMS Of therapy:
*To eliminate or significantly lessen the abnormal
sphincter activity or to circumvent it
10
Dept of Urology, GRH and KMC, Chennai.

11. 1.Oral medical therapy:
a. Alpha antagonist
b.Benzodiazepine , baclofen , dantrolene
not enjoyed great success
2.CIC with(therapy to control detrusor
overactivity)
3.Sphincterotomy
4.Stent placement across the sphincter
5.Injection of Botulinum toxin into the
sphincter
6.Continous catheterization
7.Urinary diversion. 11
Dept of Urology, GRH and KMC, Chennai.

12. FUTURE TRENDS :
1.Targetted deletion of the gene for neuronal
nitric oxide synthetase
-- by instillation cold water into urinary
bladder
-- under trial
2. nitric oxide donors
-- Isosorbide dinitrate on external sphincter
12
Dept of Urology, GRH and KMC, Chennai.

13. 13
Dept of Urology, GRH and KMC, Chennai.