High rate of urinary symptoms in older HSPers

Impaired bladder function the main cause


9 out of 12 HSPers averaging 65 years old and almost 20 years with HSP experienced urinary symptoms, mainly:

  • bladder overactivity during filling, and

  • under activity during emptying.

This combination is known as DHIC (detrusor hyperactivity with impaired contraction).



In order to investigate lower urinary tract function in hereditary spastic paraplegia (HSP), we recruited 12 HSP patients: 8 men, 4 women; mean age, 64.6 years; mean disease duration, 18.9 years; walk without cane, 2, walk with cane, 6, wheelchair bound, 3.


We performed urinary symptom questionnaires and a urodynamic testing in all patients. As a result, urinary symptoms were observed in all but 3, including urinary urgency/frequency (also called overactive bladder) in 9 and hesitancy/poor stream in 6. Urodynamic abnormalities included detrusor overactivity during bladder filling in 10, underactive detrusor on voiding in 8 (detrusor hyperactivity with impaired contraction [DHIC] in 5), detrusor-sphincter dyssynergia (DSD) on voiding in 3, and post-void residual in 5. Sphincter electromyography showed neurogenic motor unit potential in 4.


In conclusion, we observed high frequency of urinary symptoms in HSP. Urodynamics indicated that the main mechanism is DHIC with/without DSD for their urinary symptom, and sacral cord involvement in some cases. These findings facilitate patients’ care including clean, intermittent catheterization.


SOURCE: Eur Neurol. 2018 Nov 2;80(3-4):121-125. doi: 10.1159/000494030. [Epub ahead of print] PMID: 30391939


Lower Urinary Tract Function in Familial Spastic Paraplegia.


Sakakibara R1, Shimizu A2, Takahashi O2, Tateno F3, Kishi M3, Aiba Y3, Suzuki H4, Yamamoto T5, Shibata C6, Yamanishi T6.


1 Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, [email protected].

2 Clinical Physiology Unit, Sakura Medical Center, Toho University, Sakura, Japan.

3 Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan.

4 Department of Urology, Sakura Medical Center, Toho University, Sakura, Japan.

5 Neurology, Chiba University, Chiba, Japan.

6 Continence Center, Dokkyo Medical College, Tochigi, Japan.


  1. It is hard to get assistance with managing the problem. More male professionals who could recommend the correct products and fitting would be good. We have not approached NDIS and patient is reluctant to follow up “aged care” suggestions.

  2. I will keep the Baclofen in my thoughts. It is starting to happen. I might need some assistance, I am 71.

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