Pathogenesis of reduced or increased bladder sensation

Area of Science:

• Urology
• Neurology
• Nephrology

Background:

• The underlying causes of altered bladder sensation, whether reduced or increased, remain poorly understood.
• Investigating these alterations in patients with neurological or mental health conditions is crucial for understanding bladder dysfunction.

Purpose of the Study:

• To systematically determine the prevalence of reduced and increased bladder sensation in patients with neurological and mental diseases.
• To identify the primary causes of these sensory alterations in the studied population.

Main Methods:

• Analysis of 911 referred patients' data, including diagnoses, lower urinary tract symptom questionnaires, urodynamic studies, and neurological examinations.
• Definition of reduced bladder sensation as bladder volume at first sensation >300 ml and increased sensation as <100 ml.
• Stratification of patients based on the presence or absence of detrusor overactivity (DO).

Main Results:

• Neuropathies are the leading cause of reduced bladder sensation (33.3-43.8%), followed by myelopathies (17.4-25.0%) and brain diseases (9.6%).
• Myelopathies are the most frequent cause of increased bladder sensation without DO (25.0-40.0%), with neuropathies as the second most common (17.3-22.2%).
• Brain and mental diseases contribute less frequently to increased bladder sensation (e.g., 20.0% in psychogenic bladder dysfunction).

Conclusions:

• Neuropathies are identified as the primary cause of reduced bladder sensation in neurological and mental health conditions.
• Increased bladder sensation without DO is mainly linked to peripheral/central sensory pathway lesions, basal ganglia issues, and psychogenic bladder dysfunction.
• Addressing both reduced and increased bladder sensation is vital for improving patients' quality of life.