Bladder problems with HSP

7 in 10 HSPers report urgency

In this study, urgency was the most dominant complaint (72.4%), followed by frequency (65.5%), urinary incontinence (55.2%) and hesitancy (51.7%). However, HSPers do not have an abnormal risk of upper urinary tract complications as do those with spinal cord injury.



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.



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.



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.



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.


SOURCE: Spinal Cord. 2012 Jan 31. [Epub ahead of print] PMID: 22289900


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

Fourtassi M, Jacquin-Courtois S, Scheiber-Nogueira MC, Hajjioui A, Luaute J, Charvier K, Maucort-Boulch D, Rode G.


1] INSERM; UMR-S 864, Bron, France [2] Université Lyon 1, Villeurbanne, France [3] Hospices Civils de Lyon, Hôpital Henry Gabrielle, Service de Médecine Physique et de Réadaptation, Saint-Genis-Laval, France.



  1. Even drastic measures (surgery, drugs,) are unlikely to FIX this problem. Articles on MANAGEMENT for male and females are needed, so that some semblance of normal social life can be maintained. Is “Paraquad” the only organisation which offers a service in this area?

  2. A two-part series on bladder ( & bowel ( issues was published on this website last December and in March this year respectively. There are several organisations listed there that provide information, resources and education plus various means of support for people with incontinence problems.

    There is also information under the RESOURCES tab on the website ( Just click on RESOURCES in the main menu bar at the top and scroll down.

    Every article ever published in all sections of this website are available in the archive that you can access in two ways:
    1. Using the ‘Search’ function at the top of any page on the website. Just enter a keyword or two to find what is available on that topic.
    2. Click on the relevant section heading on the website homepage (in white type on a dark blue band, e.g. Research Highlights). This will take you to the complete archive for that section, where you can scroll through all the articles that have been published.

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