Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies.
Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies.
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DOI：
10.3978/j.issn.2223-4683.2016.01.08
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发表时间：
2016-02
影响因子：
2
通讯作者：
Stoffel JT
中科院分区：
文献类型：
--
作者：
Stoffel JT
逼尿肌括约肌协同失调（DSD）是逼尿肌收缩引起的膀胱出口梗阻伴不自主尿道括约肌激活的尿动力学描述。DSD与神经系统疾病相关，如脊髓损伤、多发性硬化和脊柱裂，如果不进行适当的随访和治疗，一些患有DSD的神经源性膀胱患者可能有自主神经反射障碍、复发性尿路感染或上尿路损害的风险。最常见的诊断是在尿动力学检查的排尿阶段，使用肌电图记录和排尿膀胱尿道造影，虽然尿道压力监测也可能被使用。DSD可以细分为连续性或间歇性，尽管这一术语的采用并不普遍。对于这种情况，很少有有效的口服药物治疗选择，但经尿道肉毒杆菌毒素注射在减少膀胱出口梗阻方面显示出暂时的疗效。在几项研究中，尿道括约肌切开术也证明了可重复的长期受益，但与此手术相关的发病率可能很高。
Detrusor sphincter dyssynergia (DSD) is the urodynamic description of bladder outlet obstruction from detrusor muscle contraction with concomitant involuntary urethral sphincter activation. DSD is associated with neurologic conditions such as spinal cord injury, multiple sclerosis, and spina bifida and some of these neurogenic bladder patients with DSD may be at risk for autonomic dysreflexia, recurrent urinary tract infections, or upper tract compromise if the condition is not followed and treated appropriately. It is diagnosed most commonly during the voiding phase of urodynamic studies using EMG recordings and voiding cystourethrograms, although urethral pressure monitoring could also potentially be used. DSD can be sub-classified as either continuous or intermittent, although adoption of this terminology is not widespread. There are few validated oral pharmacologic treatment options for this condition but transurethral botulinum toxin injection have shown temporary efficacy in reducing bladder outlet obstruction. Urinary sphincterotomy has also demonstrated reproducible long term benefits in several studies, but the morbidity associated with this procedure can be high.