[Neurogenic bladder dysfunction a main disability of decompression sickness: a case report]

Bladder dysfunction is common in the acute phase of decompression sickness and often precedes motor disorders. Few studies have reported the persistence of urinary problems, and no prior reports describe a neurogenic bladder in the primary presentation of decompression sickness.

We report the case of a 21-year-old female scuba diver with no medical history. After two successive deep dives, dysbaric myelitis developed. The risk factors were foramen ovale and history of diving. The patient initially showed tetraparesia, which was quickly followed by paraparesia with urinary retention. Treatment consisted of recompression with high concentrations of inspired oxygen, aspirin administration and continuous drainage by an indwelling catheter. No lesion was found on 2 sessions of magnetic resonance imaging (MRI) (cerebral and spinal), and somatosensory-evoked potentials were normal. Motor-evoked potential onset latencies were delayed. Neuro-urodynamic investigations revealed detrusor sphincter dysynergia and detrusor overactivity. On quick, complete motor recovery, the patient returned to work and continued with sports (except scuba diving). A year later, she still had urinary and faecal urgencies which were not completely resolved with medication and altered her quality of life.

Half of the cases of neurological decompression involve dysbaric myelitis. Venous ischemia is the most likely cause. Foramen ovale is an important risk factor, but the pathophysiology is obscure. Bladder problems, common in the acute phase of decompression sickness, may be the primary presentation, and may be prolonged.