Complications need management
Around 75% of older HSPers experience lower urinary tract symptoms such as urgency, hesitancy and incontinence, with some developing complications that include infections, stones, swelling of the kidneys due to urine buildup, and kidney failure.
HSPers with urinary issues should seek specialist assessment to improve management and avoid or diminish complications, resulting in better quality of life.
Hereditary spastic paraplegia (HSP) represents a clinically and genetically heterogeneous group of neurodegenerative diseases, with a worldwide estimated prevalence of 1.3/100,000 . The “pure” form of HSP is characterized by a progressive spastic paraplegia, often associated with lower urinary tract symptoms (LUTS) (72.4% to 77.6%) [2,3]. However, urologic complications are rarely reported. The aim of this study was to characterize clinical and urodynamic aspects of LUTS following HSP, and to describe treatment and urological complications of LUTS in a large series of HSP patients.
MATERIALS/PATIENTS AND METHODS:
We performed a monocentric retrospective evaluation based on review of medical records of HSP patients admitted in the department of PRM from 1999 to 2016. Inclusion criteria were patients>18years. Presenting HSP. Clinical, urodynamic and radiologic data were recorded. Statistical analysis was performed using Microsoft Excel software.
Thirty-three HSP patients were included. Mean age was 62±14 years with 70% of men. The mean follow-up was 8.10±5 years. Patients presented LUTS: urgency (85%), hesitancy (85%), nocturia (56%) and urinary incontinence (54%). The post-void residual volume (PVR) was over 100mL in 70%. NDO was diagnosed according to urodynamic testing in 83% of patients, associated in 76% of them with a detrusor-sphinctger-dyssinergia (DSD). HSP patients were exposed to urologic-nephrologic complications: febrile urinary tract infections (25%), urolithiasis (21%), hydronephrosis (8%) and renal failure (17%). HSP patients have been mainly treated with anticholinergics (69%) and 10% were switched to intradetrusor botulinum toxin. Clean intermittent catheterization was performed by 30% of patients. Three patients underwent a non-continent surgical urinary diversion.
A significant percentage of HSP patients presenting with LUTS mainly resulting of the association of PVR, DO and DSD. However, for the first time, uro-nephrologic complications following LUTS related to HSP are underlined. Thus, HSP patients should be assessed, such as SCI patients, in order to improve management and HSP patients’ quality of life with a decrease of uro-nephrologic complications.
SOURCE: Ann Phys Rehabil Med. 2016 Sep;59S:e104. doi: 10.1016/j.rehab.2016.07.230. Copyright © 2016. Published by Elsevier Masson SAS. PMID: 27676711 DOI: 10.1016/j.rehab.2016.07.230
Neurogenic detrusor overactivity in patients with hereditary spastic paraplegias.
Joussain C1, Levy J2, Charlanes A3, Even A3, Falcou L3, Chartier-Kastler E4, Denys P3.
1 Versailles Saint-Quentin University, Versailles, France, Medical School Paris Île-de-France Ouest, Inserm U1179, Montigny-le-Bretonneux, France. Electronic address: [email protected].
2 Versailles Saint-Quentin University, Versailles, France, Medical School Paris Île-de-France Ouest, Inserm U1179, Montigny-le-Bretonneux, France.
3 Hôpital Raymond-Poincaré AP-HP, Department of Physical Medicine and Rehabilitation, Garches, France.
4 Pitié-Salpêtrière Academic Hospital, Assistance Publique-hôpitaux de Paris, Pierre and Marie Curie Medical School, Paris 6 University, Department of Urology, Paris, France.