|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.