Detrusor External Sphincter Dyssynergia (DESD)
DESD is a serious urologic condition most frequently seen in patients with spinal cord injury and multiple sclerosis. It is caused by lesions between the brain stem and the lower part (sacral region) of the spinal cord. Damage to the nervous system can create a lack of coordination between the bladder and the external sphincter muscle, which is the muscle that controls the emptying of the bladder.
As a result, the bladder can’t empty completely, which creates a buildup of urinary pressure. DESD is a combination of these two factors and can lead to serious urinary tract damage and life-threatening consequences.
Detrusor external sphincter dyssynergia (DESD) is caused by lesions between the brain stem and the lower part (sacral region) of the spinal cord. It is most frequently seen in patients with spinal cord injury and multiple sclerosis, who have suffered severe trauma to their nervous system.
When detrusor external sphincter dyssynergia (DESD) occurs, there is a lack of coordination between the bladder and the external sphincter muscle, which is the muscle that controls the emptying of the bladder. Instead, when the detrusor muscle of the bladder contracts, the external sphincter may spasm and stay closed, rather than relax and allow urination. The opposing contractions cause pressure in the bladder to rise dangerously and result in the serious condition of being unable to empty your bladder.
There are several options for treating detrusor external sphincter dyssynergia (DESD).
UroLume® Urethral Stent
The UroLume® urethral stent from AMS is currently the gold standard for treating DESD. UroLume is a mesh tube that holds the urethra open; it is placed through the urethra in an outpatient procedure. While this procedure results in ongoing incontinence like all DESD treatments do, it has the benefit of being potentially reversible. So if the spinal cord injury ever was able to be repaired, the sphincter would still be intact and continence could potentially be restored.
Transurethral Sphincterotomy (TUS)
In the past, the main option for resolving DESD was to perform a transurethral sphincterotomy. This endoscopic procedure involves cutting and removing the external sphincter muscle. With the sphincter muscle cut, urine cannot be stored in the bladder. To manage urinary control, permanent use of pads or catheters is required. With advances in nerve treatment, most patients don’t like the idea of cutting that muscle entirely—and living with incontinence forever even if their spinal cord nerve damaged is eventually resolved.
Botulinim Toxin Injections
Another treatment alternative for DESD involves injection of Botulinum Toxin into the external sphincter. The toxin paralyzes the external sphincter, causing the urethra to remain open. Urine is then able to flow out of the body. Initially, to achieve the maximum effect, you will need about three or four injections given a week apart. Because the effect of the toxin lasts only a month or two, the injections need to be repeated. Further research is ongoing for this treatment option.
A thin tube, called a catheter, can be inserted through the urethra into the bladder to drain the urine from the body. This treatment option requires reinsertion of the catheter on a regular basis.
Muscle relaxants are a common type of medication used to treat DESD. Some of these drugs may help relax the muscles in the bladder. Others relax the external sphincter so that it will allow urine to flow out of the bladder. These drugs can have side effects such as drowsiness, dizziness and headaches.
Seeing a Physician
Due to the potentially severe consequences of detrusor external sphincter dyssynergia (DESD), urologists carefully manage patients with the condition so that excessive bladder pressures do not occur. Talk to a urologist to determine what treatment options are right for you.
To learn more about Detrusor External Sphincter Dyssynergia (DESD), it is important to understand how the bladder works normally.
In men, the urinary sphincter muscle is located below the prostrate. The sphincter muscle surrounds the urethra.
When the sphincter muscle tightens, it holds urine in the bladder. When it relaxes, the bladder contracts and the urethra opens, allowing urine to flow outside the body.
Damage to the nervous system can create a lack of coordination between the bladder and the external sphincter muscle.