Urodynamic studies in evaluating detrusor sphincter dyssynergia and their effects on the treatment.

One of the most frequent difficulties in the rehabilitation of the hyperreflexic bladder in patients with spinal cord injuries is vesico-sphincter-dyssynergia. Comprehensive urodynamic investigations of bladder pressure, abdominal pressure, urethral sphincter electromyography, cystometry and urethral flow were performed. In patients with vesico-sphincter-dyssynergia two methods of treatment were applied: conservative, by alpha-blocking agents, and surgical by incision of the urethral sphincter or bladder neck. In 80 per cent conservative measures were successful in early cases, whereas this figure fell to 50 per cent when undertaken at a later stage. Ten per cent required surgical measures, usually incision of the external urethral sphincter. Sometimes in difficult cases monitoring micturition cysto-urethrography was performed.