[Urination disorders in HIV infected patients].
OBJECTIVE
Manifestations of urological involvement, including tumour development, infection and impaired micturition are frequent in patients with acquired immunodeficiency syndrome. The frequency and consequences of dysuria itself are difficult to evaluate due to the concomitant effects of underlying infections, obstructive or neurological pathologies.


METHODS
Thirty-nine HIV-positive patients presenting impaired micturition including isolated dysuria, urine retention pollakiuria or urge incontinence were followed prospectively from February 1989 to September 1992. Each patient underwent a complete neurological and urological examination. Imaging included CT-scan or magnetic resonance imaging of the brain or spinal cord, echography of the bladder and prostate, intravenous pyelography or ascending and micturition urethrocystography as required. Urinary function tests were used to determine the cause and exact type of impairment to establish therapeutic protocols.


RESULTS
A neurological origin was found in 61.5% of the cases. Cerebral toxoplasmosis and HIV encephalitis were the most commonly found causes. Symptomatic relief was obtained in most patients with bladder- sphincter active drugs. After a mean follow-up of 9 months (range 2-24 months), long-term improvement was achieved in 57.9%. Seventeen patients (44%) died within a delay of 2 to 24 months (mean 8 months) after onset of dysuria.


CONCLUSIONS
Signs of impaired micturition are frequently encountered in HIV-infected patients. A full work-up is needed for diagnosis and treatment adaptation. Neurological disease is the most frequent underlying cause and would appear to be a sign of poor prognosis.
Hermieu
J F
JF
Clinique Urologique, Hôpital Bichat, Paris.
Mane
M
M
Boccon-Gibod
L
L
D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D018792:Encephalitis, Viral / Q000150:complications*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications*; D016781:Toxoplasmosis, Cerebral / Q000150:complications*; D014555:Urination Disorders / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics
D000317:Adrenergic alpha-Antagonists; D018680:Cholinergic Antagonists