Bladder dysfunction in hereditary spastic paraplegia: a clinical and urodynamic evaluation

Abstract

Objectives: Hereditary spastic paraplegia (HSP) is a degenerative central nervous system disorder characterized by progressive spasticity and hyperreflexia of the lower limbs. Often, patients with HSP experience symptoms of voiding dysfunction. Urodynamic evaluations of these patients are rarely reported in the literature and the etiology of voiding dysfunction remains unclear. The present study characterizes lower urinary tract dysfunction in a large series of patients. Methods: The medical records of 29 HSP patients who underwent urodynamic evaluation were retrospectively analyzed. The history of lower urinary tract symptoms was noted and the urodynamic findings analyzed. Results: Urgency was the most dominant complaint (72.4%), followed by frequency (65.5%), urinary incontinence (55.2%) and hesitancy (51.7%). The urodynamic findings showed signs of central neurogenic bladder in 24 patients (82.7%), with detrusor overactivity (DO) in 15 patients (51.7%) and detrusor sphincter dyssynergia (DSD) in 19 (65.5%). Post-void residual (PVR) of 410% of the voided volume was found in 12 patients (41.4%). There were significant relationships between detrusor overactivity and PVR (P¼0.005), frequency (P¼0.046) and nocturia (P¼0.045). Ultrasound examination revealed no upper urinary tract complications. Conclusion: Despite the presence of DO and DSD, HSP patients do not seem to have a high risk of developing ultrasonographicallyassessed upper urinary tract complications after a mean follow-up of 22 years, contrary to spinal cord injury population. These results may guide practitioners in their decision-making about the appropriate evaluation and treatment of bladder disturbances that accompany hereditary spastic paraplegia.

Urological dysfunction in patients with hereditary spastic paraplegia

“…The two main complaints were equally urgency and voiding dysfunction, mixing storage and voiding symptoms, accounting for more than two‐thirds of our cohort. These results slightly are higher than those found in literature ranging from 51% to 72.4% and 51.7% to 59.2% for urgency and hesitancy, respectively . Associated with incontinence episodes and/or urinary retention, these symptoms were highly evocative of NDO with DSD, confirmed by urodynamic examination in more than 80% of our patients.…”

Clinical and genetic heterogeneity in hereditary spastic paraplegias: From SPG1 to SPG72 and still counting

“…HSP patients do not seem to have a higher risk of developing upper urinary tract complications even after a long-term follow up of two decades 20 .…”

Lower Urinary Tract Function in Familial Spastic Paraplegia

“…Bladder autonomic dysfunction is known to occur and it affects significantly patients' quality of life in HSP [1,2]. However, only a few detailed urodynamic assessments are available thus far [3][4][5][6]. In this study, we describe the urodynamic findings in patients with HSP.…”

“…Urodynamics was performed in 10 patients, showing DSD in 4 and introduced anticholinergics and CIC on these patients. Fourtassi et al [6] studied 29 patients urodynamically, showing urinary urgency in 72%, urge urinary incontinence in 55%, and hesitancy in 51%; post-void residual (> 10% of bladder capacity) in 41%, DO during filling in 52%, and DSD in 66%. However, some of these reports did not clearly describe storage and voiding phase abnormalities.…”