A 28-year-old man sustained a complete spinal cord injury at the T10 level 3 months ago. He now has urinary retention with involuntary detrusor contractions against a closed external sphincter, high detrusor pressures and bilateral hydronephrosis on ultrasound. What is the urodynamic diagnosis?

• A Detrusor areflexia with compliant bladder
• B Cortical sensory incontinence
• C Bladder outlet obstruction from benign prostatic hyperplasia
• D Detrusor sphincter dyssynergia ✓

Explanation

A suprasacral cord lesion above the sacral micturition centre disconnects the pontine micturition centre from coordinated control, producing detrusor overactivity with simultaneous contraction of the external sphincter, termed detrusor sphincter dyssynergia. The resulting high storage pressures cause upper tract dilatation and threaten renal function, mandating prompt management with antimuscarinics and clean intermittent catheterisation. Sacral or cauda equina lesions instead produce detrusor areflexia with a flaccid, low-pressure bladder.

Reference: Campbell-Walsh Urology, 12th ed.

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