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Pengobatan
Sasaran:Identifikasi sebelum memulai terapi
Evaluasi:Perubahan tujuan spesifik dicoba

_______________________________________________________ Tekad:Evaluasi klinis yang sering

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Pemantauan urodinamik:Perbaikan dan resolusi gejala
_______________________________________________________ DSD
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 Agen farmakologis

Stankovic dkk: Tamsulosin 0,4 mg pada pasien MS dengan

DSDè perbaikan sisa pasca berkemih dan rata-rata berkemih
urin

Leyson dkk: Baklofen intratekal menurunkan resistensi sfingter

uretra eksternal

Oksibutinin intravesikal: Pengobatan tambahan untuk pasien

dengan kandung kemih terlalu aktif neurogenik dan DSD

Keseluruhan: Data terbatas untuk mendukung kemanjuran

dan uji coba terbatas

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Kateterisasi intermiten:Manajemen andalan dalam
tanda/gejala terkait DSD
Durasi: Tidak ada pedoman khusus > kurangi volume
berdiri dan kurangi kejang
Kateter menetap: Dipertimbangkan untuk pasien dengan
penurunan kondisi fisik yang tidak dapat melakukan IC
dan pertimbangan tabung suprapubik
Komplikasi: - ISK berulang (10,5%)
- Trauma Uretra (4,6%)
-Batu Kandung Kemih (2,9%)
-Nyeri atau Ketidaknyamanan (54,5%)
Injeksi Botox
Dykstra dkk: Injeksi BTX A setiap minggu ke sfingter
eksternal (3 minggu) > manfaat dalam 50 hari
Cochrane meta analisis: Meningkatkan beberapa tindakan
urodinamik seperti tekanan pengosongan dan PVR setelah
30 hari
Pendekatan: Melalui sistoskopi atau USG transperineal (2-
4 tempat) > posisi jam 9 sampai jam 3
Via sistoskopi: Setidaknya 1 cm lebih dalam dari yang
biasanya dilakukan untuk agen penggembur
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Ureteral Stent

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1. Pilihan pengobatan yang kontroversial
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eksternal disfungsi
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Sphincterectomy
Relaksasi Panggul

1. Relaksasi Diagfragma
Tujuan: Mengurangi obstruksi outlet dengan merusak fungsi
2. Peregangan : - Pose Bayi Bahagia, Pose anak-anak,
sfingter eksternal dan untuk menciptakan tekanan penyimpanan
Peregangan Adduktor, Peregangan piriformis
kandung kemih yang rendah

Pendekatan: Reseksi baik dengan elektrokauter atau

melalui pisau dingin dan perawatan difokuskan pada lokasi jam

12
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Kesimpulan

1. Didiagnosis melalui urodinamik pada pasien kandung

kemih neurogenik

2. Mungkin terkait dengan ISK rekuren, disrefleksia

otonom, atau kompromi saluran atas

3. Rekomendasi pengobatan > injeksi toksin botulinum A,

sphincterotomy transurethral, dan relaksasi dasar

panggul