Urinary Symptoms and Bladder Dysfunction in Patients with Neuromyelitis Optica Spectrum Disorders: Evaluation with Urodynamics and Management

Abstract

Objective To assess lower urinary tract symptoms (LUTSs) in patients with neuromyelitis optica spectrum disorders (NMOSDs) and bladder dysfunction through urodynamics (filling and voiding phase of cystometrography) and management based on findings. Patients and Methods The study included 42 (34 females) patients admitted to the rehabilitation department. Neurologic evaluation was performed and severity of myelitis was assessed using the American Spinal Injury Association Impairment Scale. All patients underwent urodynamics, and management was based on the findings. Results Mean age was 34.5 years (range: 11–64 years; standard deviation: 13.1). Twenty-three (54.8%) patients had a first episode of myelitis, whereas 19 patients had relapses (number of episodes varying from 2 to 7). Eleven (26%) patients had increased frequency, 16 (37%) had urgency, 12 (28%) had urge incontinence, 8 (18.6%) had stress incontinence, 22 (52.4%) had nocturia, 31 (72%) had retention of urine, 22 (52.4%) had incomplete evacuation, and 14 (33.3%) patients had mixed urinary complaints. The common urodynamic findings were neurogenic detrusor overactivity (NDO) with detrusor-sphincter dyssynergia (DSD) in 14 (33.3%) patients, NDO without DSD in 8 (19%), and acontractile detrusor in 20 (47.6%). Pharmacotherapy was advised to 22 (52.4%) patients, whereas clean intermittent catheterization (CIC)/self-catheterization was advised to 39 (92.9%) patients. Conclusions Urinary retention was observed to be the most common urinary complaint in patients with NMOSD followed by NDO with or without sphincter dyssynergia. Urodynamics should be performed in all patients with LUTSs for best management. CIC remains the gold standard for the management of neurogenic bladder dysfunction.

Symptomatic and restorative therapies in neuromyelitis optica spectrum disorders

“…In another cross-sectional analysis, in a cohort of 60 NMOSD patients, 47 patients (78%) reported bladder symptoms [ 58 ]. The most bothersome life sequela due to these urinary symptoms were, feeling worn out (89%), travel restrictions (77%), need to frequently change undergarments (74%), and limitation on performing daily activities (70%) [ 8 ] Beyond these effects on QOL, are the significant healthcare expenditures that result from recurrent urinary tract infections, sacral ulcer development, and prolonged hospital stays [ 59 ].…”

“…Based on urodynamic studies from 23 NMOSD patients during the initial phase of an attack, urinary retention was the predominant finding [ 59 ]. After resolution of this “spinal shock” episode, patients often develop symptoms of increased frequency, urgency, nocturia, and incontinence over the following 4–6 weeks [ 59 ]. In the same study, urodynamics were performed in 42 NMOSD patients in remission.…”

“…In the same study, urodynamics were performed in 42 NMOSD patients in remission. The most common urodynamic findings were non-contractile detrusor (47.6%) and neurogenic detrusor overactivity with (33.3%) or without (19%) detrusor-sphincter dyssynergia [ 59 ]. Thus, patients can have components of urinary retention mixed with urinary incontinence.…”

“…Thus, patients can have components of urinary retention mixed with urinary incontinence. Furthermore, it was noted that despite complete resolution of neurologic symptoms in some patients, no NMOSD patients had normal urodynamic studies, indicating that there is no definitive correlation between sensorimotor recovery and resolution of autonomic dysfunction [ 59 ].…”

Neuromyelitis optica in a young patient presenting with urinary retention: A case report

“… 2 Urodynamic assessment is an important diagnostic tool that can be used to evaluate patients with urinary retention, including those with. 3 Treatment options for urinary complications in NMO include medications, catheterization, and neuromodulation.…”