Urinary dysfunction and autonomic control in amyloid neuropathy

Abstract

Uro-neurological assessment was performed in four patients with small-fiber neuropathy due to amyloidosis (2 transthyretin-type/2 immunoglobulin light-chain-type). Voiding difficulties were due to detrusor weakness and impaired bladder sensation. In two patients cholinesterase inhibition treatment caused urge incontinence, indicating detrusor denervation supersensitivity. The underlying mechanisms of urinary dysfunction seem to involve postganglionic cholinergic and afferent somatic nerves.

Bladder dysfunction in peripheral neuropathies

“…The postulated underlying mechanism may be degeneration of postganglionic cholinergic and afferent somatic nerves. 66,69 The consensus for management of bladder dysfunction due to amyloidosis is clean, intermittent, periodic self-catheterization, particularly when post-void residual volume is large. 66,69 Because of impaired bladder sensation, scheduled catheterization should be performed in order to avoid possible injury from bladder overdistention.…”

“…66,69 The consensus for management of bladder dysfunction due to amyloidosis is clean, intermittent, periodic self-catheterization, particularly when post-void residual volume is large. 66,69 Because of impaired bladder sensation, scheduled catheterization should be performed in order to avoid possible injury from bladder overdistention. 45 Care must be taken, however, because a-adrenergic blocking agents can exacerbate the postural hypotension which is common in these patients.…”

“…In the familial form, the deposits are produced from abnormally folded transthyretin gene products (ATTR). [66][67][68] Regardless of differences in the substance of the amyloid deposit, small-fiber neuropathy is seen in AL and ATTR amyloidosis. [66][67][68] Amyloid neuropathies are rare, but well known.…”

“…[66][67][68] Regardless of differences in the substance of the amyloid deposit, small-fiber neuropathy is seen in AL and ATTR amyloidosis. [66][67][68] Amyloid neuropathies are rare, but well known. 47,66,67 Autonomic dysfunction in either type of amyloidosis may cause lower urinary tract dysfunction in around 30% of cases.…”

“…[66][67][68] Amyloid neuropathies are rare, but well known. 47,66,67 Autonomic dysfunction in either type of amyloidosis may cause lower urinary tract dysfunction in around 30% of cases. Impairment of the lower urinary tract can manifest as urinary retention and urinary incontinence.…”