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Therapeutic Interventions for Detrusor Overactivity with Detrusor External Sphincter Dyssynergia in Spinal Cord Injury

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As reviewed above, SCI commonly results in the loss of the coordinated relationship between the detrusor muscle of the bladder and the urethral sphincters. If this dyssynergia is not managed, increased intravesical pressures can lead to vesicoureteric or vesicorenal reflux, and ultimately lead to hydronephrosis and renal failure. In addition, persistent detrusor overactivity with or without DSD can contribute to maladaptive trabeculation and hypertrophy of the bladder wall, as well as reduced bladder volumes (capacity). The goals of managing detrusor overactivity with or without DSD are twofold: 1) to enhance bladder volume while lowering bladder filling pressures, and 2) to empty the bladder regularly in a low pressure manner. The latter is usually accomplished with intermittent catheterization (IC) in people with an anatomically intact external sphincter, or external drainage in people that have had a procedure to physically or chemically obliterate the external sphincter (sphincterotomy). Methods to enhance bladder volumes will be discussed first; which is most applicable to individuals performing IC.