Case 3: Detrusor-Sphincter Dyssynergia (DSD) / Neurogenic Outflow Obstruction

Clinical Scenario: 42yo Spinal Cord Injury (T6 SCI) patient presenting with involuntary detrusor contractions and severe micturition interruption. Peak telemetry: Qmax = 5.0 mL/s, PdetQmax = 110 cmH2O, EMG spikes > 90 uV.

Neurogenic Anatomical Model

Phase: Resting Baseline

Synchronized Telemetry (Qura, Pves, Pabd, Pdet, Pura, Pclos, EMG)

Initializing neurogenic DSD telemetry stream...
Timeline: 0s

Dual-Gender ICS Nomogram Comparison & Clinical Diagnostic

Clinical Diagnostic

CLASSICAL DSD (NEUROGENIC BOO)

Male ICS Criteria

BOOI: 100.0 (Severe BOO)
BCI: 135.0 (Strong Power)

Female Solomon–Greenwell

fBOOI: 102.5 (Severe fBOO)
PIP1: 115.0 cmH2O (Strong Power)

Pathophysiologic Diagnostic

Spastic EUS EMG bursts force Pura & Pclos to 85 cmH2O during detrusor contraction.

⚠️ Upper Tract Danger: CRITICAL

PdetQmax = 110 cmH2O (>40 threshold). High reflux & VUR risk. Needs CIC + Anticholinergics/Botox.

Mentor's Note Compare how both Male & Female nomogram algorithms correctly classify this neurogenic pattern as Severe BOO (BOOI 100 vs fBOOi 102.5).

Male ICS-PFS Nomogram

Female Solomon–Greenwell Plot

Academic References & Core Guidelines

  • EAU Guidelines on Neuro-Urology (2026). Section: Detrusor-Sphincter Dyssynergia (DSD) & Upper Tract Protection.
  • Weld KJ, Dmochowski RR. (2000). Association of urodynamic findings and upper tract deterioration in spinal cord injury. J Urol.

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💬 AI Case Mentor & Discussion

Have questions about Detrusor-Sphincter Dyssynergia (DSD), male vs. female nomogram criteria, or renal protection protocols? Ask our expert AI mentor below.

AI Mentor: Welcome to Case 3! You are observing classic Detrusor-Sphincter Dyssynergia (DSD) in a T6 SCI patient. Compare both nomograms above: Male BOOI = 100.0, Female fBOOI = 102.5. Notice how spastic EMG bursts block flow completely. What would you like to discuss?