Oh, *Detrusor Sphincter Dyssynergia* (DSD), that delightful dance between detrusor contractions and involuntary urethral muscle spasms, especially in the VIP lounge of patients with spinal cord lesions above the sacral cord. It’s like the detrusor and the urethral muscles are in a toxic relationship, where one wants to let go (urinate), and the other clamps down harder, leading to a scenario where nobody wins, especially not the bladder.

So, what happens when this dysfunctional duo starts their performance? High urethral closure pressures during the detrusor’s solo act, resulting in a bladder that’s under so much pressure it could probably shoot a stream to the moon, and leaving behind a significant amount of urine, because, why not? This can lead to a fun array of complications in up to a whopping 50% of patients if left unchecked. Because, apparently, regular follow-ups are more of a suggestion than a requirement.

And how do we address this medical soap opera? With symptomatic management that’s more about putting a band-aid on a bullet wound than actually fixing the underlying issue. Because, why get to the root of the problem when you can just trim the leaves and hope for the best? It’s the medical equivalent of “if it ain’t broke, don’t fix it,” except it *is* broke, and we’re just really good at pretending it’s not.