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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2004 Feb;75(2):287–291.

Micturition disturbance in acute idiopathic autonomic neuropathy

R Sakakibara 1, T Uchiyama 1, M Asahina 1, A Suzuki 1, T Yamanishi 1, T Hattori 1
PMCID: PMC1738903  PMID: 14742606

Abstract

Objective: To define the nature of micturition disturbance in patients with acute idiopathic autonomic neuropathy (AIAN).

Methods: Micturitional symptoms were observed during hospital admissions and the in outpatient clinics in six patients with clinically definite AIAN (typical form in four, cholinergic variant in one, autonomic-sensory variant in one). Urodynamic studies included medium-fill water cystometry, external sphincter electromyography, and a bethanechol test.

Results: Four patients had urinary retention and two had voiding difficulty as the initial presentation. Patients with retention became able to urinate within a week (two to seven days). The major symptoms at the time of urodynamic studies (three weeks to four months after disease onset in most cases) were voiding difficulty and nocturnal frequency. None had urinary incontinence. Complete recovery from the micturition disturbance took from three months to >18 years. The recovery period was shorter in a patient with cholinergic variant, and it was longer in two patients who had a longer duration of initial urinary retention. Micturition disturbance tended to improve earlier than orthostatic hypotension. The major urodynamic abnormalities were detrusor areflexia on voiding (5), denervation supersensitivity to bethanechol (3); low compliance detrusor (1); and impaired bladder sensation (2). None had neurogenic motor unit potentials of the external sphincter muscles.

Conclusions: In patients with AIAN, urinary retention and voiding difficulty are common initial presentations. The underlying mechanisms seem to be pre- and postganglionic cholinergic dysfunction with preservation of somatic sphincter function. The bladder problems tend to improve earlier than orthostatic hypotension.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Asahina M., Kuwabara S., Suzuki A., Hattori T. Autonomic function in demyelinating and axonal subtypes of Guillain-Barré syndrome. Acta Neurol Scand. 2002 Jan;105(1):44–50. doi: 10.1034/j.1600-0404.2002.00099.x. [DOI] [PubMed] [Google Scholar]
  2. Blaivas J. G. The neurophysiology of micturition: a clinical study of 550 patients. J Urol. 1982 May;127(5):958–963. doi: 10.1016/s0022-5347(17)54147-6. [DOI] [PubMed] [Google Scholar]
  3. Colan R. V., Snead O. C., 3rd, Oh S. J., Kashlan M. B. Acute autonomic and sensory neuropathy. Ann Neurol. 1980 Oct;8(4):441–444. doi: 10.1002/ana.410080419. [DOI] [PubMed] [Google Scholar]
  4. Harik S. I., Ghandour M. H., Farah F. S., Afifi A. K. Postganglionic cholinergic dysautonomia. Ann Neurol. 1977 Apr;1(4):393–396. doi: 10.1002/ana.410010411. [DOI] [PubMed] [Google Scholar]
  5. Kaplan S. A., Te A. E., Blaivas J. G. Urodynamic findings in patients with diabetic cystopathy. J Urol. 1995 Feb;153(2):342–344. doi: 10.1097/00005392-199502000-00013. [DOI] [PubMed] [Google Scholar]
  6. Kirby R. S., Fowler C. J., Gosling J. A., Bannister R. Bladder dysfunction in distal autonomic neuropathy of acute onset. J Neurol Neurosurg Psychiatry. 1985 Aug;48(8):762–767. doi: 10.1136/jnnp.48.8.762. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Low P. A., Dyck P. J., Lambert E. H., Brimijoin W. S., Trautmann J. C., Malagelada J. R., Fealey R. D., Barrett D. M. Acute panautonomic neuropathy. Ann Neurol. 1983 Apr;13(4):412–417. doi: 10.1002/ana.410130407. [DOI] [PubMed] [Google Scholar]
  8. Mericle R. A., Triggs W. J. Treatment of acute pandysautonomia with intravenous immunoglobulin. J Neurol Neurosurg Psychiatry. 1997 May;62(5):529–531. doi: 10.1136/jnnp.62.5.529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Palace J., Chandiramani V. A., Fowler C. J. Value of sphincter electromyography in the diagnosis of multiple system atrophy. Muscle Nerve. 1997 Nov;20(11):1396–1403. doi: 10.1002/(sici)1097-4598(199711)20:11<1396::aid-mus7>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  10. Pavesi G., Gemignani F., Macaluso G. M., Ventrua P., Magnani G., Fiocchi A., Medici D., Marbini A., Mancia D. Acute sensory and autonomic neuropathy: possible association with coxsackie B virus infection. J Neurol Neurosurg Psychiatry. 1992 Jul;55(7):613–615. doi: 10.1136/jnnp.55.7.613. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Sakakibara R., Hattori T., Kuwabara S., Yamanishi T., Yasuda K. Micturitional disturbance in patients with Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. 1997 Nov;63(5):649–653. doi: 10.1136/jnnp.63.5.649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Siroky M. B., Olsson C. A., Krane R. J. The flow rate nomogram: II. Clinical correlation. J Urol. 1980 Feb;123(2):208–210. doi: 10.1016/s0022-5347(17)55859-0. [DOI] [PubMed] [Google Scholar]
  13. Skehan A. M., Downie J. W., Awad S. A. The pathophysiology of contractile activity in the chronic decentralized feline bladder. J Urol. 1993 May;149(5):1156–1164. doi: 10.1016/s0022-5347(17)36339-5. [DOI] [PubMed] [Google Scholar]
  14. Snape J., Duffin H. M., Castleden C. M. Urodynamic findings in sacrococcygeal chordoma. Br J Urol. 1987 Jan;59(1):50–52. doi: 10.1111/j.1464-410x.1987.tb04578.x. [DOI] [PubMed] [Google Scholar]
  15. Suarez G. A., Fealey R. D., Camilleri M., Low P. A. Idiopathic autonomic neuropathy: clinical, neurophysiologic, and follow-up studies on 27 patients. Neurology. 1994 Sep;44(9):1675–1682. doi: 10.1212/wnl.44.9.1675. [DOI] [PubMed] [Google Scholar]
  16. Takayama H., Kazahaya Y., Kashihara N., Kuroda H., Miyawaki S., Ota Z., Ogawa N. A case of postganglionic cholinergic dysautonomia. J Neurol Neurosurg Psychiatry. 1987 Jul;50(7):915–918. doi: 10.1136/jnnp.50.7.915. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Wheeler J. S., Jr, Siroky M. B., Pavlakis A., Krane R. J. The urodynamic aspects of the Guillain-Barré syndrome. J Urol. 1984 May;131(5):917–919. doi: 10.1016/s0022-5347(17)50709-0. [DOI] [PubMed] [Google Scholar]
  18. Young R. R., Asbury A. K., Adams R. D., Corbett J. L. Pure pan-dysautonomia with recovery. Trans Am Neurol Assoc. 1969;94:355–357. [PubMed] [Google Scholar]
  19. Young R. R., Asbury A. K., Corbett J. L., Adams R. D. Pure pan-dysautonomia with recovery. Description and discussion of diagnostic criteria. Brain. 1975 Dec;98(4):613–636. doi: 10.1093/brain/98.4.613. [DOI] [PubMed] [Google Scholar]

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