{"id":32797,"date":"2026-09-12T18:28:00","date_gmt":"2026-09-12T22:28:00","guid":{"rendered":"https:\/\/www.rigicon.com\/?post_type=glossary-term&p=32797"},"modified":"2026-09-13T06:08:00","modified_gmt":"2026-09-13T10:08:00","slug":"dissinergia-do-detrusor","status":"publish","type":"glossary-term","link":"https:\/\/www.rigicon.com\/pt-br\/glossary-term\/dissinergia-do-detrusor\/","title":{"rendered":"Dissinergia do Detrusor"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"featured_media":0,"template":"","glossary-category":[124],"glossary-product":[108,107],"class_list":["post-32797","glossary-term","type-glossary-term","status-publish","hentry","glossary-category-urinary-incontinence-related-conditions","glossary-product-conticlassic-aus","glossary-product-contireflex-enhanced-aus"],"acf":{"gt-definition":"

A dissinergia detrusor-esf\u00edncter (DSD) \u00e9 uma condi\u00e7\u00e3o urol\u00f3gica caracterizada pela falta de coordena\u00e7\u00e3o entre o m\u00fasculo detrusor da bexiga e o esf\u00edncter uretral externo durante a mic\u00e7\u00e3o.1<\/sup> Essa disfun\u00e7\u00e3o ocorre quando o m\u00fasculo detrusor se contrai contra uma via de sa\u00edda vesical fechada devido \u00e0 contra\u00e7\u00e3o involunt\u00e1ria do esf\u00edncter urin\u00e1rio.2<\/sup> Do ponto de vista fisiol\u00f3gico, a DSD provavelmente representa a interrup\u00e7\u00e3o do trato espinobulboespinhal entre o centro pontino da mic\u00e7\u00e3o (PMC) e o n\u00facleo de Onuf’s, o que resulta em altas press\u00f5es de fechamento uretral durante uma contra\u00e7\u00e3o do detrusor.1<\/sup><\/p>\n

Durante a mic\u00e7\u00e3o normal, o m\u00fasculo detrusor se contrai enquanto o esf\u00edncter uretral externo relaxa, permitindo que a urina flua livremente. No entanto, na DSD, essa coordena\u00e7\u00e3o \u00e9 perdida, levando a dificuldades no esvaziamento da bexiga, aumento da press\u00e3o vesical e reten\u00e7\u00e3o urin\u00e1ria.3<\/sup> Press\u00f5es elevadas e sustentadas do detrusor superiores a 40 cm de \u00e1gua t\u00eam sido associadas \u00e0 hidronefrose e \u00e0 deteriora\u00e7\u00e3o renal.2<\/sup> Isso indica um aumento da press\u00e3o de perda sob ponto de detrusor, uma caracter\u00edstica frequentemente observada na DSD, especialmente do tipo cont\u00ednuo.2<\/sup><\/p>","gt-synonyms":"Dissinergia Detrusor-Esf\u00edncter (DSD), Dissinergia Vesicoesfincteriana, Dissinergia Detrusor-Esf\u00edncter Externo (DESD), Hiperatividade Neurog\u00eanica do Detrusor (HND), Descoordena\u00e7\u00e3o Vesicoesfincteriana, Dissinergia Detrusor-Esf\u00edncter Estriado","gt-citation":"[1] Stoffel JT. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies. Transl Androl Urol. 2016;5(1):127-135. DOI: 10.3978\/j.issn.2223-4683.2016.01.08\n\n[2] Feloney MP, Levin RM, Brandes SB. Bladder Sphincter Dyssynergia. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK562166\/\n\n[3] Pereira JA, Padilla-Fern\u00e1ndez B, Aguilar-Ruiz J, M\u00fcller-Arteaga C, Esperto F, G\u00f3mez de Vicente JM, Romero-Otero J, Coelho F, V\u00edrseda-Chamorro M, Breda A, Palou J, Errando-Smet C. Evaluation Methods of Detrusor Sphincter Dyssynergia in Neurogenic Bladder: A Systematic Review. Uro. 2022; 2(2):15-31. DOI: 10.3390\/uro2020015\n\n[4] Koca O, Kaya C, M\u00fcsl\u00fcmano\u011flu AY. Rigicon ContiClassic and ContiReflex artificial urinary sphincters: a new hope for male stress urinary incontinence. Transl Androl Urol. 2024;13(1):95-97. DOI: 10.21037\/tau-23-124","gt-clinical-context":"

A dissinergia detrusor-esf\u00edncter est\u00e1 mais frequentemente associada a condi\u00e7\u00f5es neurol\u00f3gicas, como traumatismos raquimedulares, esclerose m\u00faltipla e espinha b\u00edfida.2<\/sup> Essas patologias neurol\u00f3gicas afetam as vias do sistema nervoso central que controlam o armazenamento e o esvaziamento da urina, levando \u00e0 perda de coordena\u00e7\u00e3o entre o m\u00fasculo detrusor e os esf\u00edncteres urin\u00e1rios.1<\/sup><\/p>\n

A DSD \u00e9 classificada em tr\u00eas tipos com base no padr\u00e3o de atividade esfincteriana durante a contra\u00e7\u00e3o do detrusor:2<\/sup><\/p>\n

    \n
  1. Tipo 1: Aumento em crescendo da atividade esfincteriana que atinge o pico no momento m\u00e1ximo da contra\u00e7\u00e3o do detrusor, seguido pelo relaxamento do esf\u00edncter \u00e0 medida que a press\u00e3o do detrusor diminui.<\/li>\n
  2. Tipo 2: Contra\u00e7\u00f5es espor\u00e1dicas do esf\u00edncter externo ao longo de toda a contra\u00e7\u00e3o do detrusor.<\/li>\n
  3. Tipo 3: Oclus\u00e3o completa do esf\u00edncter durante toda a dura\u00e7\u00e3o da contra\u00e7\u00e3o do detrusor.<\/li>\n<\/ol>\n

    O diagn\u00f3stico da DSD \u00e9 realizado por meio de estudos urodin\u00e2micos com ou sem fluoroscopia via eletromiografia, uretrocistografia miccional ou perfilometria de press\u00e3o uretral.1<\/sup> Tem sido a experi\u00eancia do autor acompanhar achados significativos de DSD na urodin\u00e2mica com cistoscopia para descartar a possibilidade de uma estenose uretral subjacente, o que pode confundir os achados urodin\u00e2micos.1<\/sup><\/p>\n

    Os pacientes com DSD podem apresentar risco de disreflexia auton\u00f4mica, infec\u00e7\u00f5es urin\u00e1rias recorrentes ou comprometimento do trato superior se a condi\u00e7\u00e3o n\u00e3o for acompanhada e tratada adequadamente.1<\/sup> Uma associa\u00e7\u00e3o entre DSD e disreflexia auton\u00f4mica tem sido sugerida, embora a documenta\u00e7\u00e3o desse v\u00ednculo tenha se mostrado desafiadora devido \u00e0 falta de crit\u00e9rios diagn\u00f3sticos padronizados para ambas as condi\u00e7\u00f5es.2<\/sup><\/p>\n

    As op\u00e7\u00f5es de tratamento para a DSD incluem:<\/h4>\n
      \n
    1. Tratamento conservador<\/strong>: O autocateterismo intermitente limpo (CISC) combinado com antimuscar\u00ednicos \u00e9 o tratamento mais eficaz e frequentemente utilizado para a DSD.2<\/sup> Essa modalidade permite a drenagem e o esvaziamento da bexiga, mesmo na presen\u00e7a de um esf\u00edncter dissin\u00e9rgico, enquanto a terapia antimuscar\u00ednica reduz a press\u00e3o detrusoriana e minimiza as contra\u00e7\u00f5es.2<\/sup><\/li>\n
    2. Farmacoterapia<\/strong>: Alfa-bloqueadores, como a tansulosina, reduziram de maneira eficaz os volumes residuais p\u00f3s-miccionais e aumentaram os volumes eliminados.2<\/sup> Outros medicamentos incluem o baclofeno (especialmente quando administrado por via intratecal), benzodiazep\u00ednicos e dantroleno s\u00f3dico, embora nenhum destes seja atualmente recomendado como tratamento padr\u00e3o.2<\/sup><\/li>\n
    3. Inje\u00e7\u00f5es de toxina botul\u00ednica<\/strong>: A toxina botul\u00ednica administrada diretamente no m\u00fasculo esfincteriano por meio de cistoscopia ou ultrassonografia transperineal tem demonstrado efic\u00e1cia quando outros tratamentos se mostram ineficazes, com dura\u00e7\u00f5es relatadas variando de 2 a 13 meses.2<\/sup> A t\u00e9cnica envolve a inje\u00e7\u00e3o de 100 unidades de toxina botul\u00ednica A na por\u00e7\u00e3o dorsal do m\u00fasculo esfincteriano em posi\u00e7\u00f5es espec\u00edficas.2<\/sup><\/li>\n
    4. Interven\u00e7\u00f5es cir\u00fargicas<\/strong>: A esfincterotomia externa, que envolve a destrui\u00e7\u00e3o terap\u00eautica do esf\u00edncter externo, tem sido historicamente o tratamento padr\u00e3o.2<\/sup> Stents uretrais tamb\u00e9m t\u00eam sido utilizados como alternativa \u00e0 esfincterotomia, com a vantagem de serem potencialmente revers\u00edveis.1<\/sup><\/li>\n
    5. Neuromodula\u00e7\u00e3o sacral<\/strong>: Esta abordagem pode ser potencialmente muito ben\u00e9fica no tratamento da DSD, embora ainda faltem estudos randomizados e de longo prazo para confirmar sua efic\u00e1cia.2<\/sup> A neuromodula\u00e7\u00e3o sacral parece melhorar a fun\u00e7\u00e3o vesical ao reduzir as press\u00f5es miccionais m\u00e9dias do detrusor e prevenir o desenvolvimento de DSD em modelos animais experimentais espec\u00edficos de SCI.2<\/sup><\/li>\n<\/ol>\n

      Nos casos em que os pacientes n\u00e3o conseguem realizar o autocateterismo, o uso de sondas de demora, particularmente cateteres suprap\u00fabicos, \u00e9 recomend\u00e1vel.2<\/sup><\/p>","gt-related-evidence":null,"gt-featured":true,"gt-ai-referenced":true,"gt-view-count":0},"yoast_head":"\nDissinergia do Detrusor: Causas, Diagn\u00f3stico e Tratamento<\/title>\n<meta name=\"description\" content=\"A dissinergia do detrusor \u00e9 um dist\u00farbio neurog\u00eanico que causa falta de coordena\u00e7\u00e3o no esf\u00edncter urin\u00e1rio, reten\u00e7\u00e3o de urina e riscos renais graves.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.rigicon.com\/pt-br\/glossary-term\/dissinergia-do-detrusor\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dissinergia do 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