Can detrusor sphincter dyssynergia (DSD) occur in patients without a neurogenic disorder, such as a healthy male with voiding dysfunction or chronic prostatitis?

From the Guidelines

Detrusor sphincter dyssynergia (DSD) can be seen in patients without a neurogenic disorder, including healthy males with voiding dysfunction or chronic prostatitis, although it is relatively uncommon. Typically, DSD is strongly associated with neurological conditions like multiple sclerosis, spinal cord injury, or other central nervous system disorders. When DSD-like symptoms appear in non-neurogenic patients, it's often referred to as "pseudodyssynergia" or "functional DSD" 1. This condition may result from learned behavior, pelvic floor dysfunction, or psychological factors rather than true neurological impairment.

Diagnosis and Treatment

Diagnosis requires urodynamic testing with electromyography to demonstrate the inappropriate contraction of the external urethral sphincter during bladder contraction. Treatment for non-neurogenic DSD typically includes pelvic floor physical therapy, biofeedback, alpha-blockers like tamsulosin (0.4mg daily), and sometimes behavioral modification techniques 1. The underlying mechanism in these cases likely involves abnormal coordination between the bladder and urethral sphincter due to altered neural pathways or muscle dysfunction, even without obvious neurological disease.

Key Considerations

Proper diagnosis is crucial as treatment approaches differ significantly from neurogenic DSD management. It's essential to consider the patient's overall health and potential underlying conditions that may be contributing to the development of DSD-like symptoms. The standard patient is a man older than 50 years consulting a qualified health care provider for LUTS, which may or may not be associated with an enlarged prostate gland, BOO, or histological BPH 1. In clinical practice, a thorough evaluation and individualized treatment plan are necessary to address the unique needs of each patient with DSD or DSD-like symptoms.

From the Research

Detrusor Sphincter Dyssynergia in Patients Without Neurogenic Disorders

• Detrusor sphincter dyssynergia (DSD) is typically associated with neurologic conditions such as spinal cord injury, multiple sclerosis, and spina bifida 2, 3, 4.
• However, studies have shown that DSD or similar conditions can be observed in patients without neurogenic disorders, such as those with chronic nonbacterial prostatitis or voiding dysfunction 5, 6.
• A study published in 1997 found that pseudodyssynergia, a condition characterized by contraction of the external sphincter during voiding, can be misdiagnosed as chronic nonbacterial prostatitis in young men 5.
• Another study published in 2021 found that the distribution of DSD types was similar between individuals with spinal cord injury and those with no underlying neurological disorder, suggesting that DSD can occur in patients without neurogenic disorders 6.
• The study also found that none of the investigated DSD definitions can distinguish between patients with spinal cord injury and those with no underlying neurological disorder 6.

Diagnosis and Treatment

• DSD is typically diagnosed using urodynamic studies, including EMG recordings and voiding cystourethrograms 2.
• Treatment options for DSD are centered around symptomatic management, rather than addressing the underlying causative mechanisms 4.
• Behavior modification and biofeedback have been shown to be effective in decreasing symptoms in patients with pseudodyssynergia 5.
• Other treatment options, such as antimuscarinic medication, catheterization, and external sphincterotomy, may also be considered, although they can be associated with significant risks 2, 3.