Treatment of detrusor sphincter dyssynergia with baclofen and doxazosin

Detrusor sphincter dyssynergia (DSD) is an involuntary contraction of the external urethral sphincter during detrusor contraction. A high proportion of patients needing repeat surgery and long term failure have both been described in the literature. In the present study, we evaluated clinical characteristics, underlying disorders and outcomes of conservative medical treatment in 21 female patients. Two patients were newly diagnosed multiple sclerosis. Urodynamic studies were performed in all symptomatic patients, and consisted of measurement of post-micturition residuals, urethral pressure profilometry and EMG cystometry according to the criteria of the International Continence Society. All patients were treated with baclofen 15 mg/day and doxazosin 4 mg/day. Seven patients received tolterodine 4 mg/day in addition to baclofen and doxazocin because they had detrusor hyperreflexia (DH). In conclusion, treatment with either combined baclofen and doxazosin or anticholinergic agent tolterodine appeared to be effective. In addition, it should be kept in mind that DSD could be the first sign to any neurologic diseases.