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Lower Urinary Tract Function in Familial Spastic Paraplegia.

Ryuji Sakakibara1, Ayami Shimizu2, Osamu Takahashi2

  • 1Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan, sakakibara@sakura.med.toho-u.ac.jp.

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Hereditary spastic paraplegia (HSP) frequently causes lower urinary tract symptoms, primarily due to detrusor hyperactivity with impaired contraction (DHIC) and detrusor-sphincter dyssynergia (DSD). These findings guide patient care, including intermittent catheterization.

Keywords:
BladderDetrusor overactivityFamilial spastic paraplegiaOnuf’s nucleus

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Area of Science:

  • Neurology
  • Urology

Background:

  • Hereditary spastic paraplegia (HSP) is a group of inherited neurological disorders.
  • Lower urinary tract symptoms are common in neurological conditions but understudied in HSP.

Purpose of the Study:

  • To investigate lower urinary tract function in patients with hereditary spastic paraplegia (HSP).
  • To identify the urodynamic mechanisms underlying urinary symptoms in HSP.

Main Methods:

  • Recruited 12 HSP patients (mean age 64.6 years, mean disease duration 18.9 years).
  • Administered urinary symptom questionnaires.
  • Performed urodynamic testing and sphincter electromyography.

Main Results:

  • 9 out of 12 patients reported urinary urgency/frequency (overactive bladder); 6 reported hesitancy/poor stream.
  • Urodynamic abnormalities included detrusor overactivity (10 patients), underactive detrusor (8 patients), detrusor hyperactivity with impaired contraction (DHIC) (5 patients), and detrusor-sphincter dyssynergia (DSD) (3 patients).
  • Sphincter electromyography showed neurogenic motor unit potential in 4 patients.

Conclusions:

  • HSP is associated with a high frequency of lower urinary tract symptoms.
  • The primary urodynamic mechanisms are DHIC with or without DSD, suggesting sacral cord involvement in some cases.
  • Findings support the use of clean, intermittent catheterization for managing urinary symptoms in HSP patients.