management of detrusor–sphincter dyssynergia mamnaangaegmeemnetn otf o dfe dtreutrsuosro–rs–pshpihnicntecrte dry dsysyssnyenregriagia management of detrusor–sphincter dyssynergia Introduction Introduction

Introduction External sphincterotomy has been the treatment of choice for over 30 years for those afflicted with spinal cord injury (SCI) or other neurological impairment associated with detrusor hyperreflexia (DH) and detrusor-external sphincter dyssynergia (DESD) who are unable to perform clean intermittent catheterization. The procedure permits low-pressure urinary drainage, often significantly reducing post-void residual urine volumes.1 Urinary collection is accomplished using an external condom catheter after sphincterotomy, although total dribbling incontinence is unusual unless the bladder neck and prostatic urethra have been previously surgically compromised. The complications associated with external sphincterotomy include a reoperation rate ranging from 12 to 26%, haemorrhage requiring blood transfusion in 5-23% of cases, and erectile dysfunction (either complete or partial loss of erection) in 2.8-64% of patients.2-8