Neurologic diseases that cause female urinary retention
Main Article Content
urinary retention, women, lumbar spondylosis, diabetes, multiple system atrophy
Objective: The pathogenesis of female urinary retention is not well known. Hence, we systematically investigated the frequency of diseases that underlie female urinary retention in a urodynamic laboratory.
Methods: We analyzed data from 450 consecutive female patients. Data registries included the diagnosis, lower urinary tract symptom questionnaires, urodynamic study results, and neurologic exam observations. Complete urinary retention is defined as mean post-void residual (PVR) urine volume > 100 ml with no voluntary void at all; whereas incomplete urinary retention is defined as mean PVR urine volume > 100 ml after voluntary partial void.
Results: Sixty of the 450 female patients visiting our lab (13%) had urinary retention with 4 (6.7%) of these having complete retention and 56 (93.3%) having incomplete retention. The most common underlying disease in these 60 patients was lumbar spondylosis (LS), 38.3% (with 16 patients having LS alone and 7 having LS & diabetic distal polyneuropathy [DPN]), multiple system atrophy (MSA), 18.3%, and DPN, 14.4% (with 2 patients having DPN alone and 7 having LS & DPN), followed by drug-induced retention (e.g., by antidepressants), 8.3%, acute myelitis of possible demyelinating origin, 5.0%, and other etiologies. An underactive detrusor was the major urodynamic findings in those patients.
Conclusion: The present study revealed that common etiologies for female urinary retention are neurologic, e.g., an underactive detrusor due to MSA, age-related LS, and lifestyle-related DPN. Therefore LS and DPN, both common diseases, should also become major treatment targets in order to maximize patients’ quality of life.
2 Hindley RG, Brierly RD, McLarty E, Harding DM, Thomas PJ (2002). A quantitative ultrastructural study of the hypocontractile detrusor. J Urol 168: 126-131.
3 Osman NI, Chapple CR (2014). Fowler's syndrome--a cause of unexplained urinary retention in young women? Nat Rev Urol. 11: 87-98.
4 Sakakibara R, Uchiyama T, Yamanishi T, Hattori T (2003). Uro-neurological assessment in patient with spinal bifida occulta and cystica. Neurourol Urodynam 22: 328-334.
5 Hiraga A, Sakakibara R, Mori M, Yamanaka Y, Ito S, Hattori T (2006). Urinary retention can be the sole initial manifestation of acute myelitis. J Neurol Sci 251: 110-112.
6 Yamanishi T, Yasuda K, Sakakibara R, Hattori T, Uchiyama T, Minamide M, Ito H (1998). Urinary retention due to herpes simplex infections. Neurourol Urodynam 17:613–9.
7 Sakakibara R, Kishi M, Tsuyusaki Y, Tateno A, Tateno F, Uchiyama T, Yamamoto T, Yamanishi T, Yano M (2013). "Meningitis-retention syndrome": a review. Neurourol Urodyn 32: 19-23.
8 Wenning GK, Krismer F (2013). Multiple system atrophy. Handb Clin Neurol. 117: 229-241.
9 Sakakibara R, Yamamoto T, Uchiyama T, Liu Z, Ito T, Yamazaki M, Awa Y, Yamanishi T, Hattori T (2005). Is lumbar spondylosis a cause of urinary retention in elderly women? J Neurol 252: 953-957.
10 Tsai CH, Chou EC, Chou LW, Chen YJ, Chang CH, Tsou HK, Chen HT (2010). The evaluation of bladder symptoms in patients with lumbar compression disorders who have undergone decompressive surgery. Spine 35: E849-854.
11 Yamaguchi C, Sakakibara R, Uchiyama T, Yamamoto T, Ito T, Liu Z, Awa Y, Yamamoto K, Nomura F, Yamanishi T, Hattori T (2007). Overactive bladder in diabetes: a peripheral or central mechanism? Neurourol Urodyn 26: 807-813.
12 Shimizu T, Tokuda Y (2011). Acute urinary retention. Intern Med. 50: 2255.
13 Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A (2002). The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Neurourol Urodynam 21: 167-178.
14 Sakakibara R, Uchiyama T, Yamanishi T, Kishi M (2009). Sphincter EMG as a diagnostic tool in autonomic disorders. Clin Auton Res 19: 20-31.
15 Fowler CJ, Dalton C, Panicker JN (2010). Review of neurologic diseases for the urologist. Urol Clin North Am 37: 517-526.
16 Wheeler JS Jr, Culkin DJ, Walter JS, Flanigan RC (1990). Female urinary retention. Urology. 35: 428-432.
17 Erdogan MO, Yıldız H, Artan S, Solak M, Taşcıoğlu F, Dündar U, Eser B, Colak E (2011). Association of estrogen receptor alpha and collagen type I alpha 1 gene polymorphisms with bone mineral density in postmenopausal women. Osteoporos Int. 22: 1219-1225.
18 Perner A, Andersen JT, Juhler M (1997). Lower urinary tract symptoms in lumbar root compression syndromes: a prospective survey. Spine 22: 2693–2697.
19 Tsai CH, Chou ECL, Chou LW, Chen YJ, Chang CH, Tsou HK, Chen HT (2010). The evaluation of bladder symptoms in patients with lumbar compression disorders who have undergone decompressive surgery. Spine 35, 849–854.
20 Inui Y, Doita M, Ouchi K, Tsukuda M, Fujita N, Kurosaka M (2004). Clinical and radiologic features of lumbar spinal stenosis and disc herniation with neuropathic bladder. Spine 29: 869–873.
21 Sylvester PA, McLoughlin J, Sibley GN, Dorman PJ, Kabala J, Ormerod IE (1995). Neuropathic urinary retention in the absence of neurological signs. Postgrad Med J. 71(842): 747-748.
22 Hidmark A, Fleming T, Vittas S, Mendler M, Deshpande D, Groener JB, Müller BP, Reeh PW, Sauer SK, Pham M, Muckenthaler MU, Bendszus M, Nawroth PP (2014). A new paradigm to understand and treat diabetic neuropathy. Exp Clin Endocrinol Diabetes. 122: 201-217.
23 Mastri AR (1980). Neuorpathology of diabetic neuropathic bladder. Ann Intern Med 92: 316-318.
24 Van Poppel H, Stessens R, van Damme B, Carton H, Baert L (1988). Diabetic cystopathy: neuropathological examination of urinary bladder biopsies. Eur Urol 15: 128-131.
25 Yoshimura N, Chancellor MB, Andersson KE, Christ GJ (2005). Recent advances in understanding the biology of diabetes-associated bladder complications and novel therapy. BJU International 95: 733-738.
26 Sakakibara R (2015). Lower urinary tract dysfunction in patients with brain lesions. Handb Clin Neurol 130: 269-287.
27 Panicker JN, Fowler CJ (2015). Lower urinary tract dysfunction in patients with multiple sclerosis. Handb Clin Neurol 130: 371-381.
28 Schurch B, Tawadros C, Carda S (2015). Dysfunction of lower urinary tract in patients with spinal cord injury. Handb Clin Neurol 130: 247-267.
29 Fowler CJ, Panicker JN, Drake M, Harris C, Harrison SC, Kirby M, Lucas M, Macleod N, Mangnall J, North A, Porter B, Reid S, Russell N, Watkiss K, Wells M (2009). A UK consensus on the management of the bladder in multiple sclerosis. Postgrad Med J 85: 552-559.
30 The Parkinson’s disease subcommittee (Sakakibara R, Panicker J, Finazzi-Agro E, Iacovelli V, Bruschini H), The Neuourology Promotion Committee (Madesbacher H, Kastler EC, Altaweel W, Averbeck M, Davies M, Gajewski J, Gomery P, Kessler T, Liao L, Manu-Marin A, Schurch B), The International Continence Society (2015). A guideline for the management of bladder dysfunction in Parkinson’s disease and other gait disorders. Neurourol Urodynam 2015 Mar 25. doi: 10.1002/nau.22764. [Epub ahead of print] PMID: 25810035