Idiopathic detrusor sphincter dyssynergia in neurologically normal patients with voiding abnormalities.

Symptomatology and clinical manifestations of detrusor sphincter dyssynergia are described in 23 patients without neurological disease. Their cardinal symptoms were recurrent cystitis, enuresis, frequent voiding, back pain during voiding and anal discomfort. The major objective finding was vesicoureteral reflux in 11 cases with kidney scarring in 10. Bladder trabeculation was found in 13 patients, bladder hyperreflexia in 8, and significant residual urine in 16 patients. The etiology of detrusor sphincter dyssynergia in non-neurological patients is discussed. By means of exclusion it is most probable that the voiding pattern seen in detrusor sphincter dyssynergia with high frequent intermittent spasms of the urethra during voiding represents a persistent transitional phase in the development of the cerebral control of voiding. This abnormal voiding pattern which might be essential to the development of vesicoureteral reflux is under current investigation.