Detrusor-sphincter dyssynergia and dyssynergic responses: recognition and rationale for early modified transurethral sphincterotomy in complete spinal cord injury lesions.

Some characteristics are described for detrusor-sphincter dyssynergia and the dyssynergic response in spinal injury patients with complete lesions. The urodynamic evaluation and clinical problems are analyzed in 53 patients to identify the importance of early recognition of sphincter dyssynergia. Cystomanometric and urethral profile pressures vary from 30 to 150 cm. water. Although high voiding pressure, particularly associated with autonomic dysreflexia, may be indicative of sphincter dyssynergia it is not diagnostic. Relevant characteristics of patients with detrusor-sphincter dyssynergia are 1) rhythmic detrusor contractions on cystomanometry with associated marked increase in electromyographic activity on attempted voiding. These characteristics enable early recognition of dyssynergia and afford expediency in its management. The modified approach to external sphincterotomy as practiced by the author provides optimal surgical approach for urological rehabilitation of dyssynergic patients. Thus, the rationale for characterization of dyssynergia and its management by modified sphincterotomy can help to terminate long-term intermittent catheterization, remove indwelling catheter, prevent renal damage and ameliorate autonomic dysreflexia.