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Involvement of bladder neck and periurethral sphincter in dyssynergia in patients with spinal cord injury

, : Involvement of bladder neck and periurethral sphincter in dyssynergia in patients with spinal cord injury. Archivos Espanoles de Urologia 55(3): 293-302

To determine the degree of association of detrusor-periurethral dyssynergia and detrusor-bladder neck dyssynergia and if the voiding periurethral electromyographic (EMG) activity is also a valid method for diagnosing detrusor-bladder neck dyssynergia. A clinical, videourodynamic and selective periurethral EMG study was performed in 24 patients (mean age 33 years) with spinal cord injury and hyperreflexia of the bladder. The prevalence of bladder neck dyssynergia was 12.5% (3 cases) in this series. All patients with dyssynergic bladder neck also showed intermittent or sustained periurethral sphincter EMG activity. However, 15 patients showed increased intermittent or sustained voiding periurethral EMG activity that was not associated with detrusor-bladder neck dyssynergia. Utilizing the videourodynamic demonstration of detrusor-bladder neck dyssynergia as reference, selective periurethral EMG showed a sensitivity of 100% and a specificity of 29% for the diagnosis of detrusor-bladder neck dyssynergia. The finding of bladder neck dyssynergia indicates the existence of detrusor-periurethral dyssynergia. However, not all cases of detrusor-periurethral sphincter dyssynergia is associated with bladder neck dyssynergia; therefore a videourodynamic study should be performed to rule out bladder neck dyssynergia in those patients with detrusor-periurethral sphincter dyssynergia. This is important in making the differential diagnosis and also has significant therapeutic repercussions.


PMID: 12068761

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