Age-Dependent Clinical Characteristics of Micturition Syncope

Abstract

icturition syncope (MS) is a type of situational syncope in the neurally mediated syncopal syndrome. 1 MS has been described classically as a stereotype occurring in healthy men after recumbency or sleep. 2,3 Kapoor et al have proposed that the clinical features of MS may differ according to on age, 4 but information about MS is so far very limited. The purpose of this study was to clarify the age-dependent clinical characteristics of MS. MethodsThe study population consisted of 37 consecutive patients with MS referred to 3 institutions (Juntendo University Hospital, Juntendo University Shizuoka Hospital, and University Hospital of Occupational and Environmental Health) for syncope during the period August 1995 and December 2006. The mean age of the patients was 52.2± 16.8 years (range 19-76 years, median 55; 26 men, 11 women). According to the median age of the study population, we divided them into 2 groups: a younger group (YG) consisting of 18 patients aged <55 years (range 19-54 years, average 38.2 years) and an older group (OG) consisting of 19 patients aged ≥55 years (range 55-76 years, average 65.5 years). Clinical characteristics including gender, number of syncope episodes, association with other types of neurally mediated syncope and cardiovascular disease, predisposing factors, time of MS occurrence, and response to head-up tilt testing (HUT) were compared between the YG and OG. All patients underwent a standardized, basic evaluation consisting of the following: complete medical history, physical and neurologic examinations, baseline laboratory examinations, 12-lead electrocardiogram (ECG), ambulatory ECG monitoring of at least 24 h, and an echocardiographic examination. HUT was performed if informed consent was given. Other cardiac or neurologic investigations, including exercise stress test, electrophysiologic study, cardiac catheterization, coronary angiography, a computed tomographic brain scan, and electroencephalography, were performed only when clinically indicated. In all patients other causes of syncope or presyncope were excluded before performing a tilt test. Clinical information was collected retrospectively from medical records. None of the patients was administered any medication or underwent cardiac pacemaker implantation for MS.After written informed consent was given, HUT was performed in a quiet room after at least a 5-h fast. A peripheral intravenous catheter was inserted 30 min before the tilt test, and a saline solution of 4.3% glucose was started at a rate of 60 ml/h. The ECG was monitored continuously during the test, and arterial blood pressure was monitored noninvasively by a tonometry system (BP-508, Colin Electronics, Komaki, Japan). After at least 15 min resting in the supine position, each patient was positioned upright at an 80-degree angle for a maximum of 30 min on the tilt table equipped with a footboard for weight bearing (passive tilt). Age-Dependent Clinical Characteristics of Micturition Syncope

Clinical Characteristics of Defecation Syncope Compared With Micturition Syncope

“…[6][7][8][9] Our results showed that women predominated (60%) in the DS group whereas MS was more common in men (70%). Female predominance has been reported as 65-78%, 2-4 which concords with our result, but a precise explanation has not been ascertained.…”

“…Alcohol dilates the arterial and venous vessels, which leads to diminished venous return and activates the sympathetic nerve system, 10-12 as with ISP or NTG, which are used as the provocative agents in the HUT. Alcohol is a notorious precipitating factor in cases of MS. 6,9 We have reported that MS occurs more often as an alcohol-related episode in a young population, 9 but previous studies of DS do not mention alcohol intake. In the present study, we demonstrated that alcohol intake is not a major precipitating factor for DS and similar to a previous report, 13 the greater number of alcoholrelated episodes in MS may affect the difference in daily distribution.…”

“…Male dominance in MS has been identified previously, 7-9 probably related to greater alcohol intake and voiding in the standing position. [6][7][8][9] In addition, a single episode of syncope was more common with MS than with DS, probably because of more younger patients being included in the MS group.…”

Severe hypotension following urethral catheterization during general anesthesia in a patient with bladder cancer -A case report-

“…Circulatory disturbances, such as standing position, alcohol consumption, airway infection, fatigue, warmth, hypnic deprivation, and the valsalva maneuver are known trigger factors of micturition syncope [2,6-8]. Sumiyoshi et al [9] studied age-dependent clinical characteristics of micturition syncope. Micturition syncope in the younger group tended to occur in the evening or nighttime before midnight, whereas micturition syncope in the older group over 55 years tended to occur after midnight or early in the morning.…”

Sudden syncopal attack after postobstructed diuresis under combined spinal epidural anesthesia

“…However, based on the fact that the patient had no findings of cardiac abnormalities, the patient in this case might have experienced reflex micturition syncope. Micturition syncope is one type of situational syncope that occurs due to neural mediation, and usually occurs in healthy men after alcohol hyperingestion [2]. Sumiyoshi et al [2] mentioned sleeping under warm blankets and administration of a vasodilator can be factors that cause a reduction in the peripheral arterial blood resistance in the lower extremities and reported that the Valsalva maneuver is a factor that causes neurally-mediated reflex action after micturition.…”