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Urinary dysfunction and autonomic control in amyloid neuropathy.
Takashi Ito1, Ryuji Sakakibara, Tatsuya Yamamoto
1Neurology Dept., Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
Summary
Amyloidosis-related small-fiber neuropathy causes urinary dysfunction via detrusor weakness and impaired bladder sensation. Cholinesterase inhibitors can reveal denervation supersensitivity, highlighting cholinergic and somatic nerve involvement.
Area of Science:
- Neurology
- Urology
- Nephrology
Background:
- Amyloidosis can affect the peripheral nervous system, leading to small-fiber neuropathy.
- Small-fiber neuropathy can manifest with autonomic dysfunction, including urinary symptoms.
Purpose of the Study:
- To investigate the uro-neurological effects of small-fiber neuropathy in patients with amyloidosis.
- To elucidate the mechanisms underlying urinary dysfunction in this patient cohort.
Main Methods:
- Uro-neurological assessment in four patients with amyloidosis-related small-fiber neuropathy.
- Evaluation of voiding difficulties, bladder sensation, and response to cholinesterase inhibition.
Main Results:
- Patients presented with detrusor weakness and impaired bladder sensation.
- Cholinesterase inhibition induced urge incontinence in two patients, suggesting detrusor denervation supersensitivity.
- Urinary dysfunction appears linked to postganglionic cholinergic and afferent somatic nerve involvement.
Conclusions:
- Small-fiber neuropathy in amyloidosis significantly impacts bladder function.
- Autonomic denervation plays a crucial role in the observed urinary symptoms.
- Understanding these mechanisms is vital for managing uro-neurological complications in amyloidosis.