Neurological signs are common in patients with urodynamically verified “idiopathic” bladder overactivity

Abstract

Overactive bladder dysfunction is an expression of defective neuromuscular control of the lower urinary tract. The causes and the way to classify this problem are currently under debate. In some patients the overactive bladder is one sign of a neurological disorder, in so called "idiopathic detrusor instability" the cause is less obvious. That an overactive bladder has a neurogenic cause is a reasonable hypothesis. We made a detailed neurological investigation in 45 patients with idiopathic overactive bladder. Cerebrospinal fluid (CSF) was examined and blood tests for vitamin B(12)and folic acid deficiency were checked, too. In 37 of the 45 patients (82%) pathological signs were observed in the neurological tests. The most common finding was central or peripheral paresis of the legs appearing in 24 patients (53%). Of the 45 patients, eight received a neurological diagnosis, definite or possible MS or dorsal column sensation neuropathy. The results of this study give an indication of the importance of the neurological examination and suggest that neuropathy might not be uncommon in patients with so-called idiopathic detrusor instability. This also invites to reconsideration of the current classification. It is possible that a new classification based on a functional view could provide a better fundament in the search of etiologic and pathogenetic factors and also guide in the selection of the treatment most optimal for the individual patient.

Overactive bladder in diabetes: A peripheral or central mechanism?

“…36 The term 'idiopathic' is also used if there is no definite cause for DO, although neurological signs are not uncommon in patients with idiopathic DO. 37 In the present study, among the 32 patients who underwent a brain MRI scan, the frequencies of MCI in the 3 cystometric subgroups of DO, LC, and normal cystometrogram were 76.5%, 66.7%, and 50.0%, respectively; e.g., MCI was common in patients with DO. Many patients with diabetes are middle aged or elderly.…”

Do BPH Patients Have Neurogenic Detrusor Dysfunction? A Uro-Neurological Assessment

“…Although many theories (either peripheral or central) have been proposed to explain the development of DO, their pathogenesis remains unclear. The term idiopathic DO is also used if there is no definite cause for DO, although neurological signs are not uncommon in patients with idiopathic DO [12]. Previous studies have described that even after the surgical relief of BOO, DO persists in 25-93% of patients with DO [4,13], the figures increasing with age [13].…”

Motor evoked potentials from the pelvic floor

“…Gri⁄ths et al [1994] reported a ¢nding of reduced cortical perfusion and impaired cognitive function in elderly patients with urge urinary incontinence. By careful and extensive neurological workup in 45 cases of idiopathic overactive bladder, Ahlberg et al [2002] uncovered subclinical neurological disease in 82% of the patients. Fall et al [1989] provided similar evidence of underlying neurological disease in patients with overactive bladder, by utilizing the ice-water test of urothelial hypersensitivity, and Wyndaele [1993], testing electrosensitivity in the lower urinary tract, revealed abnormal innervation in 29% of patients with no previous evidence of neuropathy.…”