Editing Neurogenic LUT Dysfunction (section)

=== Detrusor sphincter dyssenergia ===
* '''Detrusor sphincter dyssynergia, unless specified otherwise, refers to dyssynergia of the striated sphincter and bladder'''
* '''True DSD should exist only in patients who have an abnormality in pathways between the sacral spinal cord and the brainstem PMC.'''
** '''The diagnosis of DSD should be suspected in any patient with a neurologic lesion in this area.'''
* '''Common causes include:'''
*# '''Traumatic SCI'''
*# '''MS'''
*# '''Transverse myelitis'''
** '''Conversely, in patients without such a lesion, this diagnosis should always be viewed with skepticism'''
* '''It is important to remember that sphincter electromyographic activity that increases simultaneously with intravesical or detrusor pressure does not always indicate true DSD. These instances are referred to as pseudodyssynergia; common causes of pseudodyssynergia include:'''
*# '''Abdominal straining to either initiate or augment a bladder contraction or in response to discomfort'''
*# '''Attempted inhibition of a bladder contraction either because of its involuntary nature or because of discomfort'''
* '''Without proper treatment, > 50% of men with DSD will develop significant complications, such as'''
*# '''VUR'''
*# '''Upper tract deterioration'''
*# '''Urolithiasis'''
*# '''Urosepsis'''
*# '''Ureterovesical obstruction'''
* '''Therapy for DSD is designed to either eliminate or significantly minimize the abnormal sphincter activity or to bypass the sphincter itself.'''
** '''Oral medical therapy directed toward the striated sphincter has not enjoyed wide success.'''
** '''The most common treatment approaches currently are:'''
**# '''CIC (usually combined with therapy to control detrusor overactivity)'''
**# '''Sphincterotomy'''
**# '''Stent placement across the sphincter'''
**# '''Injection of onabotulinumtoxinA into the sphincter'''
**# '''Continuous indwelling catheterization'''
**# '''Urinary diversion'''