The bladder neck in neurological degenerative disorders

摘要

AbstractBladder neck incompetence occurs frequently in the Shy‐Drager syndrome. The behavior of the bladder neck in patients with multiple sclerosis and Parkinson's disease, however, has not been well defined.Complete urodynamic studies were performed on 48 patients with urgency incontinence and one of the following neurological diagnoses: Parkinson's disease (13 patients), Shy‐Drager syndrome (13 patients), and multiple sclerosis (22 patients). Complete studies were also performed on 73 patients with no neurological diagnoses and no incontinence. None of the patients had ever undergone prior transurethral surgery. All patients with a neurological diagnosis had detrusor hyperreflexia on cystometrogram. Bladder neck function was evaluated with fluoroscopy as well as with intraluminal‐pressure measurements utilizing a 10 French triple‐lumen catheter.Only 11 (22) of the neurological patients had an incompetent bladder neck on fluoroscopy (6 with Shy‐Drager, 3 with Parkinson's, and 2 with multiple sclerosis). Mean bladder neck pressures of the 48 neurological patients were as follows: Parkinson's: 12 cm H2O, SE = 5; multiple sclerosis: 15 cm H2O, SE = 1.2; and Shy‐Drager: 7 cm H2O, SE = 2.Bladder neck incompetence, commonly seen in Shy‐Drager and strongly suggestive of sympathetic dysfunction, is uncommon in incontinent patients with other degenerative neurological disorders and detrusor