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a ring of muscle that contracts to close an opening (同)anatomical sphincter, sphincter_muscle

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/10 09:33:30」(JST)

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Bladder sphincter dyssynergia (also known as detrusor sphincter dysynergia (DSD) (the ICS standard terminology agreed 1998) ^[1] and neurogenic detrusor overactivity (NDO)) is a consequence of a neurological pathology such as spinal injury ^[2] or multiple sclerosis ^[3] that disrupts central nervous system regulation of the micturition (urination) reflex resulting in dyscoordination of the detrusor muscles of the bladder and the external urethral sphincter muscles. In normal lower urinary tract function, these two separate muscle structures act in synergistic coordination. But in this neurogenic disorder, the urethral sphincter muscle, instead of relaxing completely during voiding, dyssynergically contracts causing the flow to be interrupted and the bladder pressure to rise. ^[4] On cystography there is an irregular appearance of the bladder outline due to muscular contraction against the unrelaxed bladder sphincter.^[5]

Pathology and symptoms

The pathophysiology of the condition results from neuronal plasticity associated with bladder afferents and motor neurons innervating the external urethral sphincter. Symptomatically, people with this condition generally experience daytime and night time wetting, urinary retention, and often have a history of urinary tract and bladder infections. Constipation and encopresis are often associated with this condition.

Diagnosis

Strictly DSD can only be diagnosed from an EMG trace or x-ray findings, but the urodynamic trace in the image shows both the pressure and flow phenomena mentioned.^[6]

References

^ Manfred Stohrer et al (1999). "The Standardization of Terminology in Neurogenic Lower Urinary Tract Dysfunction". Neurourology and Urodynamics 18 (2): 139–158. doi:10.1002/(SICI)1520-6777(1999)18:2<139::AID-NAU9>3.0.CO;2-U. PMID 10081953.
^ Karsenty G, et al (2005). "Understanding detrusor sphincter dyssynergia--significance of chronology". Urology 66 (4): 763–8. doi:10.1016/j.urology.2005.04.061. PMID 16230135.
^ E Iu Stankovich, V V Borisov, T L Demina (1999). "Tamsulosin in the treatment of detrusor-sphincter dyssynergia of the urinary bladder in patients with multiple sclerosis". Urologiia: 48–51. ISSN 1728-2985. Urination disorders occur in 80% patients with multiple sclerosis (MS). Most common of them is detrusor-sphincter dyssynergia (DSD).
^ Corcos, Jacques; Schick, Erik (2004). Textbook of the neurogenic bladder: adults and children. Informa Health Care. pp. 163–168. ISBN 1-84184-206-0.
^ [1] Cystometry shows Neurogenic detrusor overactivity is overactivity in the presence of confirmed neuropathy in this case Multiple Sclerosis, Doug Small, Department of Urology, Southern General Hospital, Glasgow
^ [2] Cystometry shows High detrusor pressure and interrupted. Can not diagnose dyssynergia without emg or radiology but this trace is suggestive of dyssynergic voiding; Doug Small, Department of Urology, Southern General Hospital, Glasgow

External links

[3] Lester M. Libo (1983). "EMG biofeedback for functional bladder-sphincter dyssynergia: A case study". Applied Psychophysiology and Biofeedback 8.
[4] Pressure Flow Study, Department of Urology, Southern General Hospital, Glasgow

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UpToDate Contents

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1. 脊髄損傷および疾患の慢性合併症 chronic complications of spinal cord injury and disease
2. Chronic urinary retention in women
3. 尿失禁女性の尿流動態検査 urodynamic evaluation of women with incontinence
4. 小児における膀胱機能障害の評価および診断 evaluation and diagnosis of bladder dysfunction in children
5. 男性における下部尿路症状 lower urinary tract symptoms in men

English Journal

Botulinum toxin for conditions of the female pelvis.

El-Khawand D, Wehbe S, Whitmore K.SourceDivision of Female Pelvic Medicine and Reconstructive Surgery, Drexel University College of Medicine, Philadelphia, PA, USA, dominique.el-khawand@drexelmed.edu.
International urogynecology journal.Int Urogynecol J.2013 Jul;24(7):1073-81. doi: 10.1007/s00192-012-2035-1. Epub 2013 Jan 24.
INTRODUCTION AND HYPOTHESIS: Botulinum toxin has recently been approved by the Food and Drug Administration (FDA) for the treatment of urinary incontinence associated with neurogenic detrusor overactivity. However, it has also been used off-label for a multitude of other conditions in the female pel
PMID 23344218

Evidence-based review and assessment of botulinum neurotoxin for the treatment of urologic conditions.

Chancellor MB, Elovic E, Esquenazi A, Naumann M, Segal KR, Schiavo G, Smith CP, Ward AB.SourceOakland University, William Beaumont School of Medicine, Department of Urology, William Beaumont Hospital, 3535 W 13 Mile Road #404, Royal Oak, MI 48073, USA. Michael.Chancellor@beaumont.edu
Toxicon : official journal of the International Society on Toxinology.Toxicon.2013 Jun 1;67:129-40. doi: 10.1016/j.toxicon.2013.01.020. Epub 2013 Feb 13.
Botulinum neurotoxin (BoNT) can be injected to achieve therapeutic benefit across a large range of clinical conditions. To assess the efficacy and safety of BoNT injections for the treatment of certain urologic conditions, including detrusor sphincter dyssynergia (DSD), lower urinary tract symptoms
PMID 23415704

Bladder dysfunction and urodynamic study in tuberculous meningitis.

Gupta A, Garg RK, Singh MK, Verma R, Malhotra HS, Sankhwar SN, Jain A, Singh R, Parihar A.SourceDepartment of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India.
Journal of the neurological sciences.J Neurol Sci.2013 Apr 15;327(1-2):46-54. doi: 10.1016/j.jns.2013.02.006. Epub 2013 Mar 6.
BACKGROUND: Micturitional disturbances in tuberculous meningitis have been reported infrequently and that too without urodynamic studies. Bladder dysfunction in tuberculous meningitis is often considered secondary to tuberculous radiculomyelopathy. We, in this study, evaluated the incidence and patt
PMID 23472924