{"id":12755,"date":"2025-07-23T10:50:40","date_gmt":"2025-07-23T14:50:40","guid":{"rendered":"https:\/\/www.rigicon.com\/glossary-term\/detrusor-external-sphincter-dyssynergia\/"},"modified":"2025-07-23T10:50:40","modified_gmt":"2025-07-23T14:50:40","slug":"dissinergia-detrusor-esfincter-externo","status":"publish","type":"glossary-term","link":"https:\/\/www.rigicon.com\/pt-br\/glossary-term\/dissinergia-detrusor-esfincter-externo\/","title":{"rendered":"Dissinergia Detrusor-Esf\u00edncter Externo"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"featured_media":0,"template":"","glossary-category":[126],"glossary-product":[],"class_list":["post-12755","glossary-term","type-glossary-term","status-publish","hentry","glossary-category-urological-conditions"],"acf":{"gt-definition":"<p>A dissinergia detrusor-esf\u00edncter externo (DESD) \u00e9 uma condi\u00e7\u00e3o urodin\u00e2mica induzida neurologicamente, caracterizada pela contra\u00e7\u00e3o simult\u00e2nea e descoordenada do m\u00fasculo detrusor e do esf\u00edncter uretral externo durante a tentativa de mic\u00e7\u00e3o.<sup>1<\/sup> Essa dissinergia patol\u00f3gica cria obstru\u00e7\u00e3o da sa\u00edda da bexiga \u00e0 medida que o detrusor se contrai contra um esf\u00edncter uretral fechado, impedindo a bexiga eficiente esvaziamento.<sup>2<\/sup> A condi\u00e7\u00e3o ocorre devido \u00e0 ruptura do trato espinobulbospinal entre o centro de mic\u00e7\u00e3o pontina e o n\u00facleo de Onuf, resultando em press\u00f5es elevadas de fechamento uretral durante as contra\u00e7\u00f5es do detrusor.<sup>3<\/sup> A DESD est\u00e1 exclusivamente associada a patologias neurol\u00f3gicas que afetam o sistema nervoso central, particularmente aquelas que envolvem a regi\u00e3o suprassacral da coluna vertebral. cabo.<sup>4<\/sup><\/p>\n<p>A dissinergia detrusor-esf\u00edncter externo (DDE) \u00e9 uma condi\u00e7\u00e3o neurol\u00f3gica em que ocorre contra\u00e7\u00e3o simult\u00e2nea do m\u00fasculo detrusor da bexiga e do esf\u00edncter uretral externo durante a tentativa de mic\u00e7\u00e3o, em vez do relaxamento coordenado normal do esf\u00edncter. Resulta de les\u00f5es suprassacrais da medula espinhal e \u00e9 uma das causas mais perigosas de disfun\u00e7\u00e3o vesical, podendo levar \u00e0 deteriora\u00e7\u00e3o do trato urin\u00e1rio superior.<\/p>","gt-synonyms":"Dissinergia do esf\u00edncter detrusor (DSD), Dissinergia do esf\u00edncter da bexiga, Discoordena\u00e7\u00e3o neurog\u00eanica do detrusor-esf\u00edncter, Dissinergia do esf\u00edncter estriado do detrusor, Dissinergia vesicouretral","gt-citation":"[1] Feloney MP, Leslie SW. Bladder Sphincter Dyssynergia. [Updated 2023 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK562166\/\n\n[2] Stoffel JT. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies. Transl Androl Urol. 2016 Feb;5(1):127-135. DOI: 10.3978\/j.issn.2223-4683.2016.01.08\n\n[3] Blaivas JG, Sinha HP, Zayed AA, Labib KB. Detrusor-external sphincter dyssynergia. J Urol. 1981;125(4):542-544. DOI: 10.1016\/S0022-5347(17)55099-5\n\n[4] Chancellor MB, Kaplan SA, Blaivas JG. Detrusor-External Sphincter Dyssynergia. In: Clinical Neuro-Urology. 2007. DOI: 10.1002\/9780470513941.ch11\n\n[5] Gross O, Schneider MP, Bachmann LM, Kessler TM. Detrusor sphincter dyssynergia: can a more specific definition distinguish between patients with and without neurological disease? Spinal Cord. 2021;59(8):860-867. DOI: 10.1038\/s41393-021-00635-3","gt-clinical-context":"<p>A dissinergia detrusor-esf\u00edncter externo ocorre exclusivamente em pacientes com dist\u00farbios neurol\u00f3gicos que afetam o sistema nervoso central.<sup>1<\/sup> A condi\u00e7\u00e3o \u00e9 mais comumente associada a les\u00f5es da medula espinhal (particularmente les\u00f5es suprassacrais), esclerose m\u00faltipla e espinha b\u00edfida.<sup>2<\/sup> Durante o teste urodin\u00e2mico, aproximadamente 75% dos pacientes com les\u00f5es suprassacrais da medula espinhal demonstram DESD, enquanto cerca de 35% dos pacientes com esclerose m\u00faltipla e at\u00e9 50% dos beb\u00eas com espinha b\u00edfida podem apresentar esse dist\u00farbio.<sup>1<\/sup><\/p>\n <p>DESD \u00e9 classificado em tr\u00eas tipos distintos com base no comportamento do esf\u00edncter durante a contra\u00e7\u00e3o do detrusor: O tipo 1 apresenta aperto inicial do esf\u00edncter seguido de relaxamento no pico da contra\u00e7\u00e3o do detrusor; O tipo 2 envolve contra\u00e7\u00f5es espor\u00e1dicas do esf\u00edncter durante a contra\u00e7\u00e3o do detrusor; e o Tipo 3 apresenta um padr\u00e3o crescente-decrescendo de contra\u00e7\u00e3o do esf\u00edncter que obstrui a uretra durante toda a contra\u00e7\u00e3o do detrusor.<sup>1<\/sup> A DESD Tipo 1 \u00e9 comumente associada a les\u00f5es neurol\u00f3gicas incompletas, enquanto les\u00f5es neurol\u00f3gicas completas geralmente levam aos Tipos 2 e 3.<sup>1<\/sup><\/p>\n <p>Os pacientes geralmente apresentam sintomas do trato urin\u00e1rio inferior, incluindo reten\u00e7\u00e3o urin\u00e1ria cr\u00f4nica, mic\u00e7\u00e3o intermitente, mic\u00e7\u00e3o irregular de pequeno volume ou incontin\u00eancia reflexa.<sup>1<\/sup> Se n\u00e3o for tratada, a DESD pode levar a complica\u00e7\u00f5es graves, incluindo hidronefrose, cicatrizes renais e danos renais progressivos devido a press\u00f5es elevadas sustentadas do detrusor que excedem 40 cm de \u00e1gua.<sup>3<\/sup> H\u00e1 tamb\u00e9m uma associa\u00e7\u00e3o entre DESD e disreflexia auton\u00f4mica, embora faltem crit\u00e9rios diagn\u00f3sticos padronizados para ambas as condi\u00e7\u00f5es.<sup>1<\/sup><\/p>\n <p>O diagn\u00f3stico requer estudos urodin\u00e2micos com registros EMG, cistouretrograma miccional e monitoramento potencialmente da press\u00e3o uretral.<sup>2<\/sup> As abordagens de tratamento incluem autocateterismo intermitente limpo com antimuscar\u00ednicos, alfabloqueadores, inje\u00e7\u00f5es de toxina botul\u00ednica e, em casos graves, interven\u00e7\u00f5es cir\u00fargicas como esfincterotomia ou neuromodula\u00e7\u00e3o sacral.<sup>4<\/sup> Regular avalia\u00e7\u00f5es cl\u00ednicas e estudos urodin\u00e2micos repetidos s\u00e3o essenciais para monitorar a efic\u00e1cia do tratamento e prevenir danos ao trato urin\u00e1rio superior.<sup>5<\/sup><\/p>\n<p>O diagn\u00f3stico \u00e9 realizado por estudo urodin\u00e2mico com eletromiografia do esf\u00edncter. A EAU recomenda cateterismo intermitente limpo como tratamento de primeira linha, associado a anticolin\u00e9rgicos para reduzir a press\u00e3o intravesical. A inje\u00e7\u00e3o de toxina botul\u00ednica no esf\u00edncter externo \u00e9 uma op\u00e7\u00e3o para pacientes selecionados. O monitoramento regular da fun\u00e7\u00e3o renal \u00e9 mandat\u00f3rio, pois press\u00f5es elevadas podem causar refluxo vesicoureteral e insufici\u00eancia renal.<\/p>","gt-related-evidence":null,"gt-featured":true,"gt-ai-referenced":false,"gt-view-count":94},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.7 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Dissinergia Detrusor-Esf\u00edncter: Disfun\u00e7\u00e3o Neurol\u00f3gica | Rigicon<\/title>\n<meta name=\"description\" content=\"Entenda a dissinergia detrusor-esf\u00edncter externo, contra\u00e7\u00e3o simult\u00e2nea do detrusor e esf\u00edncter. 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