Urological manifestations of chronic schistosomal myeloradiculopathy.
OBJECTIVE
To describe the clinical and urodynamic features of patients with chronic voiding dysfunction secondary to schistosomal myeloradiculopathy (SM), as the clinical involvement of the spinal cord is a well recognized complication of Schistosomiasis mansoni infection.


METHODS
We reviewed the records and urodynamic studies of 26 consecutive patients (17 males and nine females, aged 8-58 years) with chronic neurological and urinary symptoms secondary to SM. The voiding function history, radiological and urodynamic findings and therapeutic approaches were reviewed. Patients with and without upper urinary tract complications were compared in terms of age, duration of voiding dysfunction and urodynamic pattern.


RESULTS
The most common urinary symptoms were difficulty in emptying the bladder (17 patients, 65%), urinary incontinence (14, 54%), and urgency and frequency (13, 50%). Laboratory and radiographic evaluation showed urinary tract infection in eight (30%) patients, bilateral hydronephrosis in five (19%) and bladder calculi in five (19%). Urodynamics showed detrusor overactivity with detrusor-external sphincter dyssynergia (DESD) in 14 patients (54%), detrusor arreflexia in six (23%), detrusor overactivity with no dyssynergia in four (15%), and detrusor underactivity in two (8%). Comparing patients with and without upper tract complications showed no differences in age and duration of urinary symptoms, but there was a significant association of detrusor overactivity with DESD and upper urinary tract complications (P = 0.04). Urological management consisted of antibiotics, clean intermittent catheterization, anticholinergic medication and stone removal, as appropriate. Conservative treatment failed in three patients and they required an injection with botulinum-A toxin into the detrusor (two) or ileocystoplasty (one).


CONCLUSIONS
Patients with chronic SM behave clinically like those with other causes of spinal cord disease and neurogenic bladder dysfunction requiring lifelong surveillance. The severity of illness in these patients should re-emphasize the need for early recognition and treatment of this condition, to prevent or reverse the neurological deficits.
Gomes
Cristiano M
CM
Division of Urology, Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. crismgomes@uol.com.br
Hisano
Marcelo
M
Machado
Luis R
LR
Figueiredo
Jose A
JA
Lucon
Antonio M
AM
Trigo-Rocha
Flavio E
FE
D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D020818:Neuroschistosomiasis / Q000150:complications*; D012189:Retrospective Studies; D012555:Schistosomiasis mansoni / Q000150:complications* / Q000503:physiopathology; D013118:Spinal Cord Diseases / Q000150:complications* / Q000503:physiopathology; D014555:Urination Disorders / Q000469:parasitology* / Q000503:physiopathology; D014563:Urodynamics / Q000502:physiology