Improve Detrusor Sphincter Dyssynergia

Treat Detrusor Sphincter Dyssynergia (Without Having To Use A Catheter)

In Detrusor Sphicnter Dyssnergia, patients have trouble feeling the urge to urinate.

 
 

Basics

 
 

The human bladder has two functions: to store and empty urine. R

In Detrusor Sphincter Dyssynergia (DSD), the detrusor muscle, urinary sphincters, and the central nervous system malfunction in coordinating with each other to perform simple bladder functions. R

These malfunctions can be disrupted by injury, inflammation, degenerative process or congenital malformation. R

DSD can increase the risk of developing Type 2 Diabetes. R

Mechanisms Of The Bladder

 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739973/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739973/

 

In the intact spinal cord, long descending fiber tracts from the midbrain coordinate the activity of the detrusor muscle and the urethral sphincte. R

For example. the detrusor muscle is relaxed while the sphincter muscle is contracted to allow for filling of the bladder, while voiding is characterized by relaxation of the urethral sphincter and contraction of the detrusor muscle. R

After SCI, input from the brainstem is partially lost. R

As such, simultaneous contractions of detrusor and sphincter emerge. R

In cystometry, detrusor sphincter dyssynergia (DSD) is in part represented by detrusor contractions against a closed urethral sphincter without release of fluid (i.e. uninhibited bladder contractions). R

In DSD, the muscle around the wall of the bladder (detrusor) contracts causing the urinary sphincter to also contract, even though the bladder is closed. R

This is how you get "dysfunctional voiding".

Pathology

 
 

DSD can happen from:

  • Spinal cord injury (SCI) and spina bifida injury R
  • Stroke (ischemic and hemorrhagic)
  • Damage to the Pons
  • Multiple sclerosis
  • Cancer
  • Dementia
  • Parkinson's Disease
  • Lock Jaw (Tetanus) R
  • Chronic prostatitis (and related infections) R
  • Herniated discs
  • Diabetes
  • HIV/AIDs
  • Cerebral Palsy
  • Poliomyetlitis
  • Guillain-Barre Syndrome
  • Postherpetic Neuralgia
  • Neuromyelitis optica spectrum disorders R

Microbiome

The microbiome of the bladder and metabolites may play a role in DSD.

For example in urinary incontinence (UUI), the inability to control the detrusor function, the urinary microbiome diversity has been associated with response to solifenacin—an orally administered anticholinergic medication used to treat UUI. R

In the gut, dysbiosis has been shown to impair recovery after spinal cord injury. R

This may add more complications to DSD.

Biomarkers And Tests

These are common biomarkers:

  • C-reactive Protein R
  • IL-6 R
  • MMP2 R
  • MMP9 R
  • TNF-a R
  • Urinary NGF levels R

Treatment

 
 

Lifestyle/Diet

Supplements

Drugs

  • Botox (Botulinum A Toxin) R
  • Desmopressin R
  • Antimuscarinics R
  • Terazosin (if MS is confirmed) R

Advanced Treatments

  • Stem Cell Therapy R
  • GM6001 (a MMP inhibitor) R 
  • Olfactory mucosal transplantation (very effective in rats) R
  • Tibial nerve stimulation (for overactive bladder) 
  • Tamsulosin R
  • Baclofen (has trouble going through BBB, so needs to be taken intrathecally) R
  • Intravesical Oxybutynin R
  • Catheterization R
  • Urethral Stents R
  • Sphincterotomy R
  • Rhizotomy R

Other

  • Block α1D-Adrenoceptor (increases voiding after spinal cord injury) R
  • p75 neurotrophin inhibitors R

Caveats

Procedures to open the bladder neck/outlet, such as trans-urethral resection of the prostate (TURP) should be undertaken with caution in Shy-Drager and multiple systems atrophy, since they have a high likelihood of rendering the patient incontinent. R

More Research

  • Dorsal Root Ganglion Stimulation R
  • There are increased NPY- and VIP-containing fibres in striated muscle of the intrinsic external urethral sphincter in patients with areflexic bladder compared with those with detrusor-sphincter dyssynergia. R