Evaluation Methods of Detrusor Sphincter Dyssynergia in Spinal Cord Injury Patients: A Literature Review

Abstract

Detrusor sphincter dyssynergia (DSD) is defined as an external urethral sphincter anomalous contraction concomitant to detrusor contraction during voiding, due to a neurological disease. It commonly occurs in suprasacral spinal cord-injured (SCI) patients and can be associated with autonomic dysreflexia. DSD generates risks to the urinary system and overall health; hence, it should be promptly diagnosed and managed. Bladder neck dyssynergia is a condition that should be integrated in DSD assessment. We reviewed the literature indexed in PubMed/Medline on the evaluation methods of DSD in SCI patients. Urodynamics is the mainstay evaluation method and has a prognostic value for the progression of upper urinary tract structural degradation and renal function decline. We found a lack of consensus on the optimal urodynamics configuration when evaluating DSD, especially in obtaining and measuring the signal from external urethral sphincter (EUS) activity. It appears that a combination of recordings of voiding cystourethrography and EUS electromyography, either with or without EUS pressure measurement, is the most accurate method available for evaluating DSD. While gathering articles, we came across an interesting approach in evaluating DSD in the past: urodynamics coupled with ultrasound imaging. Despite being considered valuable from a diagnostic standpoint by some prominent authors, it is no longer represented in the current literature. In addition to the instrumental diagnosis, health professionals should consider additional clinical features when evaluating and managing DSD in SCI patients, to design a customized plan to achieve the best compromise between quality of life and urinary system protection.