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Detrusor Underactivity Model in Rats by Conus Medullaris Transection

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Hereditary spastic paraplegias: When to expect bladder dysfunction a genetic and urodynamic study.

Pauline Lallemant-Dudek^1,2, Marine Guillaud-Bataille³, Claire Hentzen⁴

¹Sorbonne Université, Paris Brain Institute (ICM Institut du Cerveau), INSERM, CNRS, Assistance Publique-Hôpitaux de Paris (APHP), University Hospital Pitié-Salpêtrière, Paris, France.

European Journal of Neurology

|December 20, 2024

Summary

Hereditary spastic paraplegias (HSP) commonly cause detrusor overactivity and detrusor-sphincter dyssynergia. Urinary symptoms in HSP patients develop after gait issues and worsen with mobility decline.

Keywords:

SPG4/SPAST bowel disorders hereditary spastic paraplegia neurogenic bladder

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Area of Science:

Neurology
Urology
Genetics

Background:

Hereditary spastic paraplegias (HSP) are a group of inherited neurological disorders.
Bladder dysfunction is a common but understudied complication of HSP.

Purpose of the Study:

To characterize the urodynamic profiles of patients with HSP.
To investigate the development and timing of bladder symptoms in relation to motor deficits in HSP.

Main Methods:

A multicentric retrospective study involving 122 patients with HSP and bladder disorders.
Review of medical and urodynamic records, including age of onset for gait and bladder symptoms, and disability stage.

Main Results:

The most common urodynamic findings were detrusor overactivity (72.1%) and detrusor-sphincter dyssynergia (65.3%).
Motor disorder onset (median 49.3 years) preceded bladder dysfunction onset (median 29.7 years).
Urinary symptoms developed later in SPAST gene mutation carriers compared to non-SPAST groups relative to spasticity onset.

Conclusions:

The prevalent urodynamic pattern in HSP aligns with upper motor neuron lesions.
Urinary disorders in HSP are secondary to spastic gait and become more frequent as walking ability declines.