September 20, 2010

Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.

Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.: "
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Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.

Neurourol Urodyn. 2009;28(5):432-7

Authors: Sakakibara R, Uchiyama T, Kuwabara S, Mori M, Ito T, Yamamoto T, Awa Y, Yamaguchi C, Yuki N, Vernino S, Kishi M, Shirai K

AIM: To examine the prevalence and mechanism of urinary dysfunction in GBS. METHODS: Urinary symptoms were observed and neurological examinations made repeatedly during hospitalization of 65 consecutive patients with clinico-neurophysiologically definite GBS. The patients included 41 men, 24 women; mean age, 41 years old; mean Hughes motor grade, 3; AIDP, 28, AMAN, 37. Urodynamic studies consisted of uroflowmetry, measurement of post-micturition residuals, medium-fill water cystometry, and external anal sphincter electromyography. RESULTS: Urinary dysfunction was observed in 27.7% of GBS cases (urinary retention, 9.2%). Urinary dysfunction was related to the Hughes motor grade (P < 0.05), defecatory dysfunction (P < 0.05), age (P < 0.05), and negatively related to serum IgG class anti-ganglioside antibody GalNAc-GD1a (P < 0.05). Urinary dysfunction was more common in AIDP (39%) than in AMAN (19%). No association was found between antibody titer against neuronal nicotinic acetylcholine receptors and urinary dysfunction. Urodynamic studies in nine patients, mostly performed within 8 weeks after disease onset, revealed post-void residual in 3 (mean 195 ml), among those who were able to urinate; decreased bladder sensation in 1; detrusor overactivity in 8; low compliance in 1; underactive detrusor in 7 (both overactive and underactive detrusor in 5); and nonrelaxing sphincter in 2. CONCLUSION: In our series of GBS cases, 27.7% of the patients had urinary dysfunction, including urinary retention in 9.2%. Underactive detrusor, overactive detrusor, and to a lesser extent, hyperactive sphincter are the major urodynamic abnormalities. The underlying mechanisms of urinary dysfunction appear to involve both hypo- and hyperactive lumbosacral nerves. Neurourol. Urodynam. 28:432-437, 2009. (c) 2009 Wiley-Liss, Inc.

PMID: 19260087 [PubMed - indexed for MEDLINE]
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Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese type.

Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese type.: "
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Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese type.

Neurourol Urodyn. 2009;28(1):26-32

Authors: Andrade MJ

AIM: Study lower urinary dysfunction in familial amyloidotic polyneuropathy (FAP). METHODS: Fifty-four FAP patients were studied. Clinical examination, urodynamics and ultrasound of the urinary tract were performed. RESULTS: Urinary symptoms appeared during the first three years of the disease in 50% of the patients. The initial urinary symptom was dysuria in 39% and incontinence in 24% of the patients, sensitivity and contractility disturbances of the detrusor were found at the initial stages. Non-relaxing urethral sphincter was found in 51,7% and dyssynergia in 37,5% of the cases. Ultrasound revealed thickening of the vesical wall in 42,5% of the patients, more common in males (M:16; F:7). Opening of the vesical neck was found in 56% of the cases (M:19; F:11) with paradoxical closure during the attempt to void. Fluctuations in the opening of the vesical neck were found in eight patients, also more frequently in males (M:6; F:2). CONCLUSIONS: In addition to reduced sensation, underactive detrusor, opening of the vesical neck and external sphincter deficit, we found data suggesting failure of relaxation of the internal and external sphincter. The overdistention associated with an open vesical neck and external sphincter deficit justifies incontinence in those patients. The retention is due to inadequate contraction of the detrusor, probably associated with non-relaxing of the internal and external sphincter. These dysfunctions derive from deposition of amyloid substance in the detrusor, but overdistention is likely to play a role. Early therapeutic intervention in these patients is vital to avoid secondary injuries.

PMID: 19089892 [PubMed - indexed for MEDLINE]
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