title: Do Sacral/Peripheral Lesions Contribute to Detrusor-Sphincter Dyssynergia?
abstract: OBJECTIVE
  While detrusor-sphincter dyssynergia (DSD) occurs in conjunction with lesions between the brainstem and the sacral cord, it is not well known whether sacral/peripheral lesions contribute to DSD. We studied the relationship between DSD and sacral/peripheral lesions.
  
  
  METHODS
  One hundred and forty-four patients with diverse neurologic etiologies underwent urodynamic study and analysis of motor unit potentials in the external sphincter muscles, 117 of whom were able to void during a urodynamic test. Sacral/peripheral lesion (SPL) is defined as neurogenic change in motor unit potentials. Detrusor overactivity (DO) is defined as involuntary detrusor contractions during the filling phase, which commonly occurs in lesions above the sacral cord. We considered DO as a putative indicator of supra-sacral lesion.
  
  
  RESULTS
  DSD was found in 44 (30.6%), SPL in 71 (49.3%), and DO in 83 (57.6%) of 144 patients, respectively. The incidence of DSD was the same in the SPL positive group (31%) and the SPL negative group (30.1%). By contrast, within the subgroup of patients without DO, the incidence of DSD was significantly more common in the SPL positive group (41.4%) than in the SPL negative group (25.0%) (P < 0.05). In 53 of the SPL positive group who were able to void, postvoid residual >100 mL was more common in patients with DSD (not statistically significant).
  
  
  CONCLUSIONS
  The results of the present study suggest that not only suprasacral pathology, but also sacral/peripheral lesions can produce DSD. In light of the previous reports, DSD might also result from partial lesions in peripheral branches of the sphincter circuit.
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahashi
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Sakakibara
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Kuniko
authors.initials: K
authors.lastname: Tsunoyama
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Fuyuki
authors.initials: F
authors.lastname: Tateno
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yano
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Sugiyama
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Uchiyama
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Awa
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Yamaguchi
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamanishi
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kishi
authors.affiliation: Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, JapanDivision of Neurology, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Urology, Tokyo Women's Medical University, Tokyo, JapanDepartment of Urology, Sakura Medical Center, Toho University, Sakura, JapanDepartment of Neurology, Chiba University, Chiba, JapanDepartment of Urology, Chiba University, Chiba, JapanCentral Laboratory Unit, Chiba University Hospital, Chiba, JapanDepartment of Urology, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tsuyuzaki
keywords: detrusor-sphincter dyssynergia; neuropathy; sacral Onuf's nucleus