Question Title: Detrusor Sphincter dysinergia

I have had urinary retention for three years. I self cath 7 times a day. Last baby three years ago. Retention started 10 weeks into pregnancy. NOT pregnancy related. Had urgency for years before retention. Most recent urodynamic studies show definite detrusor sphincter dysinergia. I have had an MRI several years ago that did not show any demyelination. I have not had CSF studies. Should I be pushing for further MS studies at this point or are there other reasonable causes for this kind of bladder dysfunction? I was not in an accident or injured to explain any spinal cord injury. I do have extreme upper back pain in scapula-neck shoulder region that has been recently diagnosed as TOS. I also have partial seizures several times monthly. I am mature (36)and intelligent and understand without examining me you cannot give an absolute diagnosis but an educated guess would be appreciated. I desperately need some leads as to where these symptoms might fall.

Dear Molly:

It is rare in adults to have a neurogenic bladder (which is what you seem to have) without an identifiable underlying neurological problem. Besides MS, diagnostic considerations include other spinal cord disorders such as trauma, tumor, or vascular disease, lesions of the cauda equina or conus medullaris, autonomic dysfunction, and a lesion of the neves in the pelvis. You probably need a neurological re-evaluation prior to further tests such as a lumbar puncture.

True neurogenic thoracic outlet syndrome (TOS) is very rare, and is rather frequently OVERDIAGNOSED and INAPPROPRIATELY TREATED WITH SURGERY. Reading your symptoms of pain, I believe that it is quite unlikely that you have TOS. I would strongly dissuade you against getting operated upon for presumed TOS unless this diagnosis is confirmed on EMG examination by at least one reputed neuromuscular specialist from a major academic neurology department. The neurology department at the Cleveland Clinic has extensive experience in this diagnosis of this condition.

I am sure that the neurologists at the Cleveland Clinic would be able to fully and competently address each of your three neurological problems. Appointments can be made by calling (800)223-2273, or (216)444-5559.