Behcet's disease and the neuropathic bladder: urodynamic features: case report and a literature review

Abstract

We report on a 16-year old patient with a neuropathic bladder secondary to Behcet's disease, which is an uncommon vasculitis usually involving venules. The genitourinary manifestations of this disease are discussed, a neuropathic bladder being a rare complication of the involvement of the nervous system. Urodynamic assessment is important when voiding dysfunction is present; three patients previously reported revealed a bladder function changing from normal detrusor to overactivity. Our patient showed early and severe involvement of the nervous system, and detrusor areflexia two years after the onset of the disease. Spontaneous voiding was restored two months after urological management (intermittent catheterization) was started.

Bladder Dysfunction in Behçet’s Disease

“…Our, 27 year old male, patient's chief complaint was urge urinary incontinence. Additionally, acute urinary retention and voiding symptoms may also be seen (7). Acute urinary retention after anticholinergic therapy was also seen in our case.…”

“…Increased intravesical pressure may cause hydroureteronephrosis or severe trabeculation of the bladder wall (3). Urodynamic tests may report detrusor hyperreflexia either sporadically or combined with impaired contractility, decreased bladder compliance or capacity, bladder hypersensitivity, hypo-or acontractile bladder and increased postvoid residual urine concomitant to the detrusor hyperreflexia (3,(5)(6)(7)(8)10). In our case bladder capacity of 365c and residual volume of 140 cc was reported by which urodynamic tests showed detrusor hyperreflexia.…”

Bladder Dysfunction due to Behçet’s Disease

“…In their report the major findings were trabeculation in the bladder (5/8 cases) and bladder ulcer or hypervascularity (2/8 cases) in cystoscopy, and detrusor hyperactivity (7/8 cases) and low compliance of bladder (4/8 cases) [1]. In past reports of bladder dysfunction due to Behçet's disease, urodynamic evaluation revealed cases of detrusor hyperreflexia, 1 case of detrusor areflexia, and detrusor-sphincter dyssynergia in a total of 4 patients [3][4][5]. These findings suggest that characteristics of neurogenic bladder due to Behçet's disease are detrusor hyperreflexia in the storage phase and detrusor-sphincter dyssynergia in the voiding phase.…”

La pathologie médullaire non traumatique

“…Leur prise en charge thérapeutique, quand il existe une atteinte mé-dullaire, n'est pas encore parfaitement codifi ée. La pathologie neurologique est retrouvée dans 75 % des cas de lupus érythémateux disséminé et dans 30 % des cas de maladie de Behçet (11)(12)(13)(14)(15)(16). Dans tous les cas, du fait de la capacité de ces pathologies de toucher de multiples organes, un bilan précis incluant la cystoscopie doit être réalisé afi n de savoir si la pathologie rencontrée est bien d'origine neurologique ou locale (Behçet).…”