DETRUSOR BLADDER NECK DYSSYNERGIA REVISITED

To our knowledge, direct measurement of active closure of the bladder neck during bladder contraction resulting in bladder neck dyssynergia and outflow obstruction has not yet been demonstrated. A total of 34 s pinal cord injury patients underwent urodynamic investigation with 2 m icro-transducer catheters in the urethrovesical and anorectal regions, respectively. Proper localization of the transducers was done with an image intensifier. The respective role of the striated and smooth mus cles on bladder neck activity was evaluated after pudendal nerve block s and phentolamine injections. Of the patients 25 had active bladder n eck dyssynergia with concomitant detrusor-sphincter dyssynergia. Press ures were higher in the bladder neck than in the bladder. Pudendal blo cks abolished detrusor-sphincter but not bladder neck dyssynergia, whi ch was decreased by additional phentolamine but only in patients in wh om bladder neck dyssynergia was associated with autonomic hyperreflexi a. Evidence is presented that active bladder neck dyssynergia may exis t in patients with a neurogenic bladder and that it is seemingly depen dent on alpha 1-postsynaptic and alpha 2-presynaptic adrenoreceptors.