Objectives: To characterize urodynamic findings after lower-level spinal cord injury (LSCI) and to evaluate a new pressure-based classification framework—the bladder–sphincter dyscoordination syndrome (BSDS)—for describing voiding patterns. We also introduce a descriptive “neurogenic bladder outlet obstruction” (NBOO) phenotype for straining-dependent voiding difficulty. Methods: We retrospectively analyzed the first urodynamic studies (December 2020–August 2024) in 81 men with LSCI (injury at T10 or below). Key urodynamic measures included detrusor and intravesical pressures during filling and voiding, bladder volumes (first desire to void and capacity), compliance, maximum flow rate (Q_max), post-void residual (PVR), voiding efficiency, and the ratio of detrusor to abdominal pressure rise (ΔPdet/ΔPabd). We compared cases with detrusor overactivity (DO) versus those without DO. Among those with voiding discoordination, we distinguished classical detrusor–sphincter dyssynergia (DSD) from a proposed NBOO phenotype (characterized by abdominal straining pressure ≥ 40 cmH₂O, detrusor pressure < 20 cmH₂O, incomplete emptying, and no anatomic obstruction). We further classified discoordination cases using the BSDS framework into four subtypes—dual high-pressure (DHP), detrusor-muscle predominant (DMP), dual low-pressure (DLP), and abdominal-pressure predominant (APP)—based on reference pressure thresholds (detrusor 20 cmH₂O; abdominal 40 cmH₂O). Results: Patients with DO (43.2%) showed significantly higher detrusor pressures during filling (at first desire to void and at capacity) and a lower first desire volume than non-DO patients, while maximum capacity was similar (p = 0.105). During voiding, DO cases had lower PVR and higher emptying rates, although the detrusor-vs-abdominal pressure contribution (ΔPdet/ΔPabd) was comparable between groups. Among 63 patients with voiding discoordination, 32 (50.8%) met NBOO criteria; these NBOO cases exhibited lower detrusor and intravesical voiding pressures but worse emptying (higher PVR) compared to classical DSD cases. Overall, 76 of 81 patients (93.8%) fit within the BSDS classification—distributed as 22 DHP, 13 DMP, 15 DLP, and 26 APP patterns. Conclusions: The BSDS framework (and the NBOO descriptor when conventional indices cannot be applied) offers a novel way to describe voiding patterns after LSCI. It links urodynamic observations to potential management strategies (by identifying whether the bladder or outlet is the primary issue). Prospective studies are needed to validate this framework against outcomes such as upper tract integrity, continence, and dependence on catheterization.

Rationale: Cancer-associated myositis (CAM) is a rare autoimmune disease linked to underlying malignancies and classified as an idiopathic inflammatory myopathy. It is characterized by a complex pathogenesis, poor prognosis, and diverse symptoms such as muscle weakness and myalgia, which may be accompanied by extramuscular manifestations. The presence of comorbidities in elderly patients can mask these symptoms, posing significant diagnostic and treatment challenges. Early recognition of CAM and detection of malignancy are crucial for improving patient outcomes. Patient concerns: A 71-year-old male presented with progressive symmetrical proximal muscle pain as the sole manifestation, without typical extramuscular manifestations. Initial tests revealed negative muscle enzyme results, but electromyography indicated myogenic damage in the proximal muscles of the limbs. Further serological testing detected positive anti-TIF1γ and anti-PL-7 antibodies. Diagnoses: The patient was diagnosed with CAM based on the presence of specific autoantibodies and a rapid clinical response to corticosteroids. Interventions: Treatment with low-dose hormone therapy resulted in significant improvement of symptoms. A comprehensive malignancy screening was performed. Outcomes: Subsequent surgical pathology confirmed the presence of colon cancer. The patient’s condition improved markedly with timely intervention and targeted treatment. At 6-month follow-up, he remained symptom-free. Lessons: This case underscores the importance of considering CAM in patients with unexplained symmetrical proximal muscle pain, even in the absence of typical extramuscular symptoms. The detection of myositis-specific autoantibodies is critical for accurate diagnosis. Early identification and treatment of the underlying malignancy can significantly improve prognosis. Future research should focus on elucidating the pathogenesis of CAM, identifying more specific biomarkers, and developing standardized diagnostic and therapeutic guidelines to enhance early diagnosis and treatment outcomes.