Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Eur J Phys Rehabil Med. 2011 Dec;47(4):639-50. Epub 2011 Nov 11.
Spinal cord injury (SCI) affects 11.5 to 53.4 individuals per million of the population in developed countries each year. SCI is caused by trauma, although it can also result from myelopathy, myelitis, vascular disease or arteriovenous malformations and multiple sclerosis. Patients with complete lesions of the spinal cord between spinal cord level T6 and S2, after they recover from spinal shock, generally exhibit involuntary bladder contractions without sensation, smooth sphincter synergy, but with detrusor striated sphincter dyssynergia (DESD). Those with lesions above spinal cord level T6 may experience, in addition, smooth sphincter dyssynergia and autonomic hyperreflexia. DESD is a debilitating problem in patients with SCI. It carries a high risk of complications, and even life expectancy can be affected. Nearly half of the patients with untreated DESD will develop deleterious urologic complications, due to high intravesical pressures, resulting in urolithiasis, urinary tract infection (UTI), vesicoureteral reflux (VUR), hydronephrosis, obstructive uropathy, and renal failure. The mainstay of treatment is the use of antimuscarinics and catheterization, but in those for whom this is not possible external sphincterotomy has been a last resort option. External sphincterotomy is associated with significant risks, including haemorrhage; erectile dysfunction and the possibility of redo procedures. Over the last decade alternatives have been investigated, such as urethral stents and intrasphincteric botulinum toxin injection. In this review, we will cover neurogenic DESD, with emphasis on definition, classifications, diagnosis and different therapeutic options available.
脊髓损伤（SCI）每年影响发达国家每百万人中有 11.5 至 53.4 人。SCI 是由创伤引起的，但也可由脊髓病、脊髓炎、血管疾病或动静脉畸形和多发性硬化症引起。完全性脊髓损伤患者（损伤水平在 T6 和 S2 之间的脊髓）在经历脊髓休克后，通常会出现无意识的膀胱不自主收缩、平滑肌协同作用，但伴有逼尿肌横纹肌协同失调（DESD）。损伤水平高于 T6 的患者可能还会出现平滑肌协同失调和自主反射亢进。DESD 是 SCI 患者的一个严重问题。它存在很高的并发症风险，甚至会影响预期寿命。未经治疗的 DESD 患者中，近一半会因高膀胱内压而发生有害的泌尿系统并发症，导致尿石症、尿路感染（UTI）、膀胱输尿管反流（VUR）、肾积水、梗阻性尿路病和肾衰竭。治疗的主要方法是使用抗毒蕈碱药物和导尿，但对于那些无法进行这些治疗的患者，括约肌切开术是最后的选择。括约肌切开术存在明显的风险，包括出血、勃起功能障碍和再次手术的可能性。在过去十年中，已经研究了替代方法，如尿道支架和内括约肌肉毒毒素注射。在这篇综述中，我们将重点介绍神经源性 DESD，包括其定义、分类、诊断和现有的不同治疗选择。
