Contemporary Treatment of Detrusor Sphincter Dyssynergia: a Systematic Review

Purpose of Review: To systematically review the literature to determine outcomes of detrusor sphincter dyssynergia (DSD) treatments. DSD can present in patients with neurogenic bladder due to a variety of conditions, but no treatment guidelines currently exist. Ovid Medline, Embase, PubMed, and Web of Science were searched within the last 10 years for “detrusor sphincter dyssynergia.” Results were independently reviewed by two coauthors for inclusion using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA) guidelines. Exclusion criteria were pediatric populations, reviews, non-clinical focus, non-English language, and case reports. Recent Findings: There were 515 articles screened to yield 21 full text articles. Fourteen were retrospective studies, five were prospective non-randomized studies, and two were prospective, randomized trials. A total of 830 patients (527 male, 104 female, and 199 not specified) had DSD from spinal cord injury (413), multiple sclerosis (104), multiple system atrophy (33), and not specified (280). Treatments included botulinum A injections into the external sphincter (seven studies, reported success rates = 64–100%) or bladder (three studies, 44–76%), urethral stents (four studies, 9–91%), sphincterotomy (two studies, 48–85%), transurethral incision of the bladder neck (one study, 82%), pharmacologic therapy (three studies, 44–76%), sacral neuromodulation (one study, 60%), and anal stretch (one study). Summary: Evaluation of treatment outcomes for DSD is lacking. If conservative therapy fails, botulinum toxin type A injection appears to be a primary intervention strategy. More invasive treatments such as sacral neuromodulation and transurethral incision of the bladder neck also demonstrated high success rates, while urethral stenting was associated with high complication and failure rates.