Value of voiding ultrasonography combined with urodynamic studies in the assessment of vesical sphincter dyssynergy

: Fifteen paraplegic patients all presenting with vesico-sphincteric dyssynergia underwent, between January and September 1990, a urodynamic and electromyographic examination combined with pre-voiding or voiding transrectal ultrasonography. The ultrasound apparatus used was a Siemens Sonoline SL1 with a MHz linear intracavitary probe giving a strictly longitudinal plane of section. The urodynamic apparatus used was a Wiest 6000 with a Bohler 7 F urethral catheter and an electromyography needle-electrode implanted in the striated sphincter. This type of ultrasonography provided a precise and dynamic image of the bladder neck, prostatic urethra and external striated sphincter during the phases of filling and voiding. Spastic contractions of the striated sphincter during detrusor contraction were observed in 8 patients with an intermittent and jerky urinary stream. In 7 patients, the striated sphincter remained closed during detrusor contraction and only opened briefly as soon as detrusor contraction decreased, allowing only a weak and transient flow. By allowing the direct visualisation of the sphincteric obstruction during voiding, dynamic transrectal ultrasonography clearly confirmed the diagnosis of vesico-sphincteric dyssynergia. In contrast with classical voiding cystourethrography, this is a non-invasive, inexpensive and, most importantly, repeatable technique, as it does not require any irradiation. It is therefore suitable for drug evaluation trials, particularly of alpha-blockers and to assess one of the many treatments proposed in vesico-sphincteric dyssynergia.