Article

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 >10% of the voided volume was found in 12
patients (41.4%). There were significant relationships between detrusor
overactivity and PVR (P=0.005), frequency (P=0.046) and nocturia (P=0.045).
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 ultrasonographically-assessed 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.

Langue : ANGLAIS