Understanding Detrusor Sphincter Dyssynergia (DSD)

Detrusor sphincter dyssynergia (DSD) is a condition where by the walls of the bladder (detrusor muscles) and the urethral sphincter muscles (inside the urethra, nearer to the outside of the body) are not coordinated, and therefore urine can’t leave the body. This issue is caused by disease or injury of the nerves that are responsible for this action.

DSD is often found as part of a neurogenic bladder. The bladder muscle is supposed to be relaxed to store urine, and then contract to expel urine. Expulsion of urine needs to be synced with the urethra being able to get the urine to the outside of the body, but in DESD, the contractions and relaxations are not out of time.¹

DSD is also called bladder sphincter dyssynergia, detrusor sphincter dyssynergia, neurogenic detrusor overactivity, and detrusor-external sphincter dyssynergia.

Symptoms of detrusor sphincter dyssynergia

Leaking urine
Incontinence
Frequent UTIs

Causes of detrusor sphincter dyssynergia

Note: micturition means urination.

DSD is caused by lesions between the brainstem (specifically, the pontine micturition centre, which just means the part of the brain that controls urethral sphincter relaxation that allows you to urinate) and the spinal cord (the sacral micturition centre, which is the part of your spinal cord that delivers the message).^2,3

Essentially, it is an interruption in the messages getting from your brain to your bladder, which can happen for various reasons (injury, disease).

Types of detrusor sphincter dyssynergia

Type 1

There is an increase in both bladder muscle (detrusor) pressure and activity of the sphincter nerves that control the muscles. When the bladder contracts, the sphincter suddenly relaxes, and there is nothing to stop the urine from flowing out. Meaning, you wet yourself involuntarily.

Type 2

There are sporadic contractions of the urethral sphincter (external) all the way through the bladder contractions, which means urine comes out in spurts, involuntarily.

So your bladder won’t empty all at once with or without your permission, but in spits and spats. This means it can be mixed up.

Type 3

The urethral sphincter remains closed throughout a bladder muscle contraction, so the urine has nowhere to go as it is blocked in.

Treatment for detrusor sphincter dyssynergia

Treatment is usually management techniques, since damage to the spinal cord or brain is usually permanent. Treatments may include using a catheter on yourself to empty the bladder, or helping to manage the contractions of either (or both) the bladder and the urethral sphincter, possibly paralysing the muscle artificially.^4,5

Complications are less common in women than men, but the condition needs to be managed adequately to avoid frequent infections and damage to the kidneys.⁶

References

1.
Stoffel J. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies. Transl Androl Urol. 2016;5(1):127-135. doi:10.3978/j.issn.2223-4683.2016.01.08
2.
Gross O, Leitner L, Rasenack M, Schubert M, Kessler TM. Detrusor sphincter dyssynergia: can a more specific definition distinguish between patients with and without an underlying neurological disorder? Spinal Cord. Published online May 7, 2021:1026-1033. doi:10.1038/s41393-021-00635-3
3.
Pereira JA, Debugne T. Evaluation Methods of Detrusor Sphincter Dyssynergia in Spinal Cord Injury Patients: A Literature Review. Uro. Published online June 1, 2022:122-133. doi:10.3390/uro2020015
4.
Gamé X, Chartier-Kastler E, Ayoub N, Even-Schneider A, Richard F, Denys P. Outcome after treatment of detrusor–sphincter dyssynergia by temporary stent. Spinal Cord. Published online May 1, 2007:74-77. doi:10.1038/sj.sc.3102069
5.
Verpoorten C, Buyse GM. The neurogenic bladder: medical treatment. Pediatr Nephrol. Published online May 2008:717-725. doi:10.1007/s00467-007-0691-z
6.
Seseke S, Leitsmann C, Hijazi S, Trojan L, Dechent P. Functional MRI in patients with detrusor sphincter dyssynergia: Is the neural circuit affected? Neurourology and Urodynamics. Published online August 8, 2019:2104-2111. doi:10.1002/nau.24112