Urinary disorders in amyotrophic lateral sclerosis subjects

Abstract

Amyotrophic lateral sclerosis (ALS) related disorders are considered to be uncommon. We hypothesize that urinary dysfunction may occur in ALS patients in the context of spasticity of pelvic floor musculature. We recorded data on 54 subjects with ALS. All subjects were evaluated with ALSFRS and M-Ashworth Scale for lower limbs. Bladder scan procedure was performed to asses post void residual (PVR) in all subjects. Forty-one percent of subjects were symptomatic for urinary disorders and 35% of subjects had a PVR > 50 ml. Linear correlation was found between PVR and ALSFRS with a R(2) 0.95 and p = 0.025; a linear correlation was also noted between PVR and lower limbs Ashworth Scale. We conclude that urinary retention is common in ALS. Urological evaluation is indicated in ALS patients with prominent spasticity.

Non‐motor manifestations in ALS patients with tracheostomy and invasive ventilation

“…Dysuria and urinary catheter insertion are often encountered in advanced ALS patients. While there have been no reports examining voiding dysfunction in patients with TIV, patients with early stages of ALS often exhibit an overactive or hypoactive bladder . Voiding difficulty is partly attributed to weakness of the pelvic or abdominal wall muscles, but a neurogenic mechanism may contribute to bladder dysfunction with disease progression.…”

“…While there have been no reports examining voiding dysfunction in patients with TIV, patients with early stages of ALS often exhibit an overactive or hypoactive bladder. [47][48][49] Voiding difficulty is partly attributed to weakness of the pelvic or abdominal wall muscles, but a neurogenic mechanism may contribute to bladder dysfunction with disease progression. Some patients with superoxide dismutase-1 gene variants have a neurogenic or atonic bladder.…”

Urodynamic findings in amyotrophic lateral sclerosis patients with lower urinary tract symptoms: Results from a pilot study

“…For example, Lopes de Carvalho et al reported a prevalence of urinary symptoms of 40% in ALS patients according to El Escorial criteria, but they do not clarify whether PLS phenotype was included or not, nor which questionnaires and methodology were used to asses LUTS. 5 Both voiding (''incomplete emptying'') and storage (''nocturia,'' ''frequency'') symptoms were frequently found (24% and 22%, respectively) but UI was seldom reported (5.5%). However, a comparison to normal population or a measure of the severity of those urinary symptoms were lacking.…”

“…These symptoms are the result of the spreading of the disease to different neuronal networks other than pyramidal tracts and supports the view of ALS as a multisystem disorder . Consequently, lower urinary tract symptoms (LUTS) have been reported in ALS patients although its prevalence differs widely between studies ranging from 4% to 40% . Moreover, underlying causes and pathophysiologic mechanisms have not been properly studied.…”

“…2 Consequently, lower urinary tract symptoms (LUTS) have been reported in ALS patients although its prevalence differs widely between studies ranging from 4% to 40%. [3][4][5] Moreover, underlying causes and pathophysiologic mechanisms have not been properly studied. Since Onuf's nucleus has been shown to remain relatively spared in ALS, 6 clinical guidelines and textbooks still consider LUTS as an atypical feature in ALS or a result of reduced mobility in advanced stages of the disease.…”