Lower Urinary Tract Symptoms in Myasthenia Gravis

Abstract

It remains uncertain to what extent lower urinary tract (LUT) symptom (LUTS) is a comorbidity of myasthenia gravis (MG). We prospectively administered a LUTS questionnaire devised for detecting neurogenic pelvic organ dysfunction (not validated) in an MG group and a healthy control group and compared the results. The MG group comprised 21 patients: 15 women and 6 men, with age range 22–73 (mean 47) years, illness duration range 0.2–8 (mean 3.5) years, median Myasthenia Gravis Foundation of America (MGFA) grade 2, all walking independently. Therapies included thymectomy in 17, predonisolone 5–20 mg/day in 10, and pyridostigmine bromide 60–180 mg/day in 9 patients. The control group, who were undergoing an annual health survey, comprised 235 consecutive subjects: 120 women and 115 men, with age range 30–69 (mean 48) years. The questionnaire had 9 questions. Each question was scored from 0 (none) to 3 (severe) with an additional quality of life (QOL) index scored from 0 (satisfied) to 3 (extremely dissatisfied). Statistical analysis was made using Student’s <i>t</i> test. Compared with the control subjects, the frequency of LUTSs in the MG patients was significantly higher for daytime frequency (43%; <i>p</i> < 0.01), nocturia (24%; <i>p</i> < 0.01), and urinary incontinence (43%; <i>p</i> < 0.05). The LUTS-related QOL index for the MG patients was significantly higher for MG patients as a whole than that for all control patients (29%) (<i>p</i> < 0.05). In conclusion, our study results showed that MG patients had significantly more LUTSs (overactive bladder) than healthy control subjects and had worse LUTS-related QOL; therefore, amelioration of LUTS in MG is important.

Development and characterization of agonistic antibodies targeting the Ig-like 1 domain of MuSK

“…Furthermore, urogenital structural or functional abnormalities are also not known to be a symptom in (MuSK) MG patients 47 – 49 . A recent prospective questionnaire-based study reported that AChR MG patients (no MuSK MG patients were included) had more often an overactive bladder than healthy controls, possibly explained by the use of pyridostigmine 50 . MuSK MG patient autoantibodies predominantly target the same Ig-like 1 domain of MuSK as our patient-derived clones 51 , as well as the antibodies used in our animal models.…”

Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study

“…In this case, urinary tract infection appeared because of prolonged intubation and immobilization, rather than as the primary cause of MC [ 7 , 35 , 44 , 46 ]. Pelvic muscle weakness led to urinary incontinence without the need for indwelling catheters, but it also predisposed patients to urinary tract infections [ 22 , 47 ].…”

Urinary incontinence as a possible signal of neuromuscular toxicity during immune checkpoint inhibitor treatment: Case report and retrospective pharmacovigilance study

“…Myasthenia gravis can predispose individuals to a higher risk of urinary incontinence by affecting the tone of the smooth or striated muscle of the distal sphincter (5). The frequency of urinary incontinence was significantly higher in patients with myasthenia gravis than in controls (26,27). Sandler et al concluded that voiding dysfunction heralded either a new diagnosis of myasthenia gravis or an exacerbation of the disease process (28).…”