Detrusor Arreflexia as an End Stage of Neurogenic Bladder in HAM/TSP?

Matheus Tannus, Davi Tanajura, Michael A Sundberg, Paulo Oliveira, Neviton Castro, André Muniz Santos, Matheus Tannus, Davi Tanajura, Michael A Sundberg, Paulo Oliveira, Neviton Castro, André Muniz Santos

Abstract

The HTLV-1 virus is a known agent involved in the development of HAM/TSP. Past studies have typically observed patients with autonomic dysfunction consisting of detrusor overactivity and detrusor-sphincter dyssynergia, with the occasional observation of underactive detrusor or detrusor arreflexia. However, studies have not yet evaluated the progression of neurogenic bladder over time. In this paper, we describe a HAM/TSP patient with the initial development of overactive detrusor, and subsequent development of detrusor arreflexia. Given a paucity of studies characterizing the effects of HTLV-1 on the autonomic nervous system, particularly aspects controlling continence, this patient's clinical course may represent one type of end point for patients with HAM/TSP and neurogenic bladder. Further cohort or case-series studies, with particular emphasis on the progression of neurogenic bladder, are needed to evaluate the significance of this described case in relation to typical disease progression patterns.

Figures

Figure 1
Figure 1
Urodynamic study performed on patient (2008) showing detrusor hyperreflexia prior to voiding. PV: vesicular pressure, PR: abdominal pressure, PV-PR: detrusor pressure, Vol: volume in bladder.
Figure 2
Figure 2
Urodynamic study performed on patient (2010) displaying detrusor arreflexia. Pves: vesicular pressure, Pabd: abdominal pressure, Pdet: detrusor pressure, Vur: urine volume, Vinf: infusion volume.
Figure 3
Figure 3
Urinary sonogram performed on patient (2010) revealing grade II hydronephrosis consistent with noncontractile bladder.

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Source: PubMed

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