Ultrasonographic study of urethral sphincter in vesico-sphincter dyssynergia

The ultrasound study of bladder neck and urethral sphincter in men could be performed by means of transrectal ultrasound scan in longitudinal scanning or by probing the surface in transperineal scanning. The endocavitary ultrasound scan study gives the best indications in the evaluation of the bladder neck in men. The neuromuscular bladder dysfunctions' (neurologic bladder), which can be studied by ultrasound scan are dyssinergia, striped detrusor, detrusor-bladder-neck dyssinergia, detrusorial iper-reflexy bladder instability. In paraplegic subjects the exam should be performed in gynecological position or in side decubitus, and micturition is obtained by means of sovrapubic percussion and compression or with prevailing action of the abdominal press. The detrusor-striped dyssinergia is the dysfunction of the bladder where the ultrasound scan results are more meaningful and give the best elements. In these cases, already in basal conditions, could be present a bladder neck half-opened. During micturition there is an ample opening of the bladder neck and of the prostatic urethra, but scarce relaxation of the membranous urethra; sometimes a protrusion of the back lip of the bladder neck could be present too. In iper-reflexy (unstable bladders) and in detrusorial ipo-reflexy, ultrasound scans could result poorly specific and non-significative.