title: Pathogenesis of reduced or increased bladder sensation.
abstract: OBJECTIVE
  Pathogenesis of reduced or increased bladder sensation is not well known. Hence, we systematically investigated the frequency of reduced or increased bladder sensation in neurologic/mental diseases.
  
  
  METHODS
  We analyzed 911 patients who were referred from within our hospital. Data registries included a diagnosis, a lower urinary tract symptom questionnaire, a urodynamic study, and neurological examinations. Reduced bladder sensation is defined as bladder volume at the first sensation >300 ml. Increased bladder sensation is defined as bladder volume at the first sensation <100 ml. These patients were stratified into those with and without DO.
  
  
  RESULTS
  Neuropathies are the most common cause of reduced bladder sensation (33.3-43.8% in diabetic neuropathy, etc.). Myelopathies are the second most common cause (17.4-25.0% in multiple sclerosis, etc.). Less common is brain diseases (9.6% in multiple system atrophy, etc.). In contrast, myelopathies are the most common cause of increased bladder sensation without DO (25.0-40.0% in spinal forms of systemic lupus erythematosus, Sjogren's syndrome, etc.). Neuropathies are the second most common (17.3-22.2% in post-pelvic organ surgery, diabetic neuropathy, etc.). Less common is brain/mental diseases (20.0% in psychogenic bladder dysfunction, 8.1% in Parkinson's disease, etc.).
  
  
  CONCLUSIONS
  The present study revealed that neuropathies are the most common cause of reduced bladder sensation in neurologic/mental diseases. Increased bladder sensation without DO occurs mainly in peripheral and central sensory pathway lesions, as well as in basal ganglia lesions and psychogenic bladder dysfunction. Reduced and increased bladder sensation should be a major treatment target for maximizing patients' quality of life.
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kuniko
authors.initials: K
authors.lastname: Tsunoyama
authors.forename: Ryuji
authors.initials: R
authors.lastname: Sakakibara
authors.forename: Chiharu
authors.initials: C
authors.lastname: Yamaguchi
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamanishi
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahashi
authors.forename: Megumi
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kishi
authors.forename: Emina
authors.initials: E
authors.lastname: Ogawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D007564:Japan; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012677:Sensation; D012684:Sensory Thresholds; D011795:Surveys and Questionnaires; D001743:Urinary Bladder / Q000294:innervation*; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D014563:Urodynamics; D055815:Young Adult