Prevalence and mechanism of bladder dysfunction in Guillain-Barré Syndrome.
OBJECTIVE
To examine the prevalence and mechanism of urinary dysfunction in GBS.


METHODS
Urinary symptoms were observed and neurological examinations made repeatedly during hospitalization of 65 consecutive patients with clinico-neurophysiologically definite GBS. The patients included 41 men, 24 women; mean age, 41 years old; mean Hughes motor grade, 3; AIDP, 28, AMAN, 37. Urodynamic studies consisted of uroflowmetry, measurement of post-micturition residuals, medium-fill water cystometry, and external anal sphincter electromyography.


RESULTS
Urinary dysfunction was observed in 27.7% of GBS cases (urinary retention, 9.2%). Urinary dysfunction was related to the Hughes motor grade (P < 0.05), defecatory dysfunction (P < 0.05), age (P < 0.05), and negatively related to serum IgG class anti-ganglioside antibody GalNAc-GD1a (P < 0.05). Urinary dysfunction was more common in AIDP (39%) than in AMAN (19%). No association was found between antibody titer against neuronal nicotinic acetylcholine receptors and urinary dysfunction. Urodynamic studies in nine patients, mostly performed within 8 weeks after disease onset, revealed post-void residual in 3 (mean 195 ml), among those who were able to urinate; decreased bladder sensation in 1; detrusor overactivity in 8; low compliance in 1; underactive detrusor in 7 (both overactive and underactive detrusor in 5); and nonrelaxing sphincter in 2.


CONCLUSIONS
In our series of GBS cases, 27.7% of the patients had urinary dysfunction, including urinary retention in 9.2%. Underactive detrusor, overactive detrusor, and to a lesser extent, hyperactive sphincter are the major urodynamic abnormalities. The underlying mechanisms of urinary dysfunction appear to involve both hypo- and hyperactive lumbosacral nerves. Neurourol. Urodynam. 28:432-437, 2009. (c) 2009 Wiley-Liss, Inc.
Sakakibara
Ryuji
R
Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan. sakakibara@sakura.med.toho-u.ac.jp
Uchiyama
Tomoyuki
T
Kuwabara
Satoshi
S
Mori
Masahiro
M
Ito
Takashi
T
Yamamoto
Tatsuya
T
Awa
Yusuke
Y
Yamaguchi
Chiharu
C
Yuki
Nobuhiro
N
Vernino
Steven
S
Kishi
Masahiko
M
Shirai
Kohji
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology; D001323:Autoantibodies / Q000097:blood; D003672:Defecation; D003950:Diagnostic Techniques, Urological; D004576:Electromyography; D005260:Female; D005732:Gangliosides / Q000276:immunology; D020275:Guillain-Barre Syndrome / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011978:Receptors, Nicotinic / Q000276:immunology; D012720:Severity of Illness Index; D013127:Spinal Nerves / Q000503:physiopathology; D001743:Urinary Bladder / Q000294:innervation / Q000503:physiopathology*; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics; D055815:Young Adult
D001323:Autoantibodies; D005732:Gangliosides; D011978:Receptors, Nicotinic