Document Detail


Urological manifestations of chronic schistosomal myeloradiculopathy.
MedLine Citation:
PMID:  16153216     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe the clinical and urodynamic features of patients with chronic voiding dysfunction secondary to schistosomal myeloradiculopathy (SM), as the clinical involvement of the spinal cord is a well recognized complication of Schistosomiasis mansoni infection. PATIENTS AND METHODS: We reviewed the records and urodynamic studies of 26 consecutive patients (17 males and nine females, aged 8-58 years) with chronic neurological and urinary symptoms secondary to SM. The voiding function history, radiological and urodynamic findings and therapeutic approaches were reviewed. Patients with and without upper urinary tract complications were compared in terms of age, duration of voiding dysfunction and urodynamic pattern. RESULTS: The most common urinary symptoms were difficulty in emptying the bladder (17 patients, 65%), urinary incontinence (14, 54%), and urgency and frequency (13, 50%). Laboratory and radiographic evaluation showed urinary tract infection in eight (30%) patients, bilateral hydronephrosis in five (19%) and bladder calculi in five (19%). Urodynamics showed detrusor overactivity with detrusor-external sphincter dyssynergia (DESD) in 14 patients (54%), detrusor arreflexia in six (23%), detrusor overactivity with no dyssynergia in four (15%), and detrusor underactivity in two (8%). Comparing patients with and without upper tract complications showed no differences in age and duration of urinary symptoms, but there was a significant association of detrusor overactivity with DESD and upper urinary tract complications (P = 0.04). Urological management consisted of antibiotics, clean intermittent catheterization, anticholinergic medication and stone removal, as appropriate. Conservative treatment failed in three patients and they required an injection with botulinum-A toxin into the detrusor (two) or ileocystoplasty (one). CONCLUSION: Patients with chronic SM behave clinically like those with other causes of spinal cord disease and neurogenic bladder dysfunction requiring lifelong surveillance. The severity of illness in these patients should re-emphasize the need for early recognition and treatment of this condition, to prevent or reverse the neurological deficits.
Authors:
Cristiano M Gomes; Marcelo Hisano; Luis R Machado; Jose A Figueiredo; Antonio M Lucon; Flavio E Trigo-Rocha
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  BJU international     Volume:  96     ISSN:  1464-4096     ISO Abbreviation:  BJU Int.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-12     Completed Date:  2005-10-20     Revised Date:  2006-07-18    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  853-6     Citation Subset:  IM    
Affiliation:
Division of Urology, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. crismgomes@uol.com.br
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Chronic Disease
Female
Humans
Hydronephrosis / parasitology
Male
Middle Aged
Neuroschistosomiasis / complications*
Retrospective Studies
Schistosomiasis mansoni / complications*,  physiopathology
Spinal Cord Diseases / complications*,  physiopathology
Urination Disorders / parasitology*,  physiopathology
Urodynamics / physiology

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