Assessment and management helps avoid complications
Standard screening for urinary system problems in people with HSP would improve detection and management, as well as reducing the incidence of complications, resulting in an overall improved quality of life for HSPers.
AIMS: Purposes of this study were to describe lower urinary tract symptoms (LUTS) and related urodynamic patterns in patients with hereditary spastic paraplegia (HSP) and to characterize LUTS management and associated uronephrological complications.
METHODS: We retrospectively reviewed medical files of HSP patients, consecutively followed in our Physical and Rehabilitation Medicine Department between 1999 and 2016. Clinical, urodynamic and radiological data were collected and analyzed. Different treatments that have been prescribed and uronephrological complications were also recorded. Patients with other neurological or urological diseases were excluded.
RESULTS: Thirty-three patients with HSP were included. Mean duration of follow-up was 8.1 ± 5 years, mean age 62 ± 14 years, and 70% were men. The most frequent LUTS was urgency and voiding dysfunction (both 69.7%). Incontinence and retention with a significant postvoid residue above 100 mL accounted for 66.7% and 57.6% of initial symptoms respectively. Neurogenic detrusor overactivity was diagnosed in 80.7% of patients. Two-thirds of our cohort were treated with anticholinergics and 9.1% required intradetrusor botulinum-toxin injections. Only 27.3% of patients performed clean intermittent self-catheterization. Febrile urinary tract infections (21.2%), urolithiasis (15,1%), hydronephrosis (6%) and chronic renal failure (9.1%) were found.
CONCLUSION: Given their high prevalence and the risk of uronephrological complications, LUTS should be systematically assessed in HSP patients. The systematic screening of urological dysfunction in this population would improve its management, decrease the incidence of uronephrological complications, and increase the quality of life.
SOURCE: Neurourol Urodyn. 2019 Apr;38(4):1081-1085. doi: 10.1002/nau.23957. Epub 2019 Mar 8. PMID: 30848841 © 2019 Wiley Periodicals, Inc.
Urological dysfunction in patients with hereditary spastic paraplegia.
1 Inserm U1179, UFR des sciences de la santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France.
2 Department of Physical Medicine and Rehabilitation, APHP-Raymond-Poincaré Hospital, Garches, France.
3 Department of Neurourology and Urodynamics Unit, APHP-Tenon Hospital, Pierre et Marie Curie Medical School, Paris, France.
4 Department of Urology, APHP-Pitié-Salpétrière Hospital, Pierre et Marie Curie Medical School, Paris, France.