title: Voiding dysfunction in patients with neuromyelitis optica spectrum disorders.
abstract: OBJECTIVE
  We assessed the lower urinary tract symptoms (LUTS) and urodynamic findings in patients with neuromyelitis optica spectrum disorders (NMO-SD), a recently defined neurological disease.
  
  
  METHODS
  We prospectively evaluated seven men and 23 women (mean age 41.1 ± 13.5 years) with an established diagnosis of NMO-SD who were invited to participate irrespective of the presence of LUTS. Neurological evaluation was assessed with the Expanded Disability Status Scale (EDSS) and LUTS were evaluated with the Overactive Bladder questionnaire (OAB-V8) and the International Prostate Symptom Score (I-PSS). All patients underwent videourodynamics, transabdominal urinary tract sonography, urine culture, and serum creatinine levels.
  
  
  RESULTS
  The mean time of disease duration was 33.8 ± 30.8 months. Neurological evaluation showed a mean EDSS score of 5.3 ± 1.8. The most frequent videourodynamic findings were detrusor-sphincter dyssynergia (DSD) and detrusor overactivity (DO) in 11 (36.6%) patients, DSD without DO in seven (23.3%) and DO without DSD in six (20.0%) patients. Voiding dysfunction assessed by I-PSS and OAB-V8 increased with the degree of neurological impairment (P = 0.018; r = 0.42 and P = 0.006; r = 0.48 respectively). Patients with DSD had higher I-PSS (18.5 ± 11.4 vs 7.0 ± 9.2; P = 0.029) and OAB-V8 scores (22.8 ± 15.8vs 9.1 ± 7.8; P = 0.008), and worse neurological impairment (mean EDSS 5.9 ± 1.8 vs 4.5 ± 1.5; P = 0.027).
  
  
  CONCLUSIONS
  Most patients with NMO-SD have LUTS and voiding dysfunction, with DSD and DO as the main urodynamic findings. The severity of the neurological disease is a predictive factor for the occurrence of voiding dysfunction and detrusor-sphincter dyssynergia.
authors.affiliation: Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Fabricio Leite
authors.initials: FL
authors.lastname: de Carvalho
authors.affiliation: Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Cristiano Mendes
authors.initials: CM
authors.lastname: Gomes
authors.affiliation: Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Samira L
authors.initials: SL
authors.lastname: Apostolos-Pereira
authors.affiliation: Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Jose
authors.initials: J
authors.lastname: Bessa
authors.affiliation: Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Marcello
authors.initials: M
authors.lastname: Pinheiro
authors.affiliation: Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Paulo E
authors.initials: PE
authors.lastname: Marchiori
authors.affiliation: Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Homero
authors.initials: H
authors.lastname: Bruschini
authors.affiliation: Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.affiliation: Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
authors.forename: Dagoberto
authors.initials: D
authors.lastname: Callegaro
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000150:complications / Q000503:physiopathology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014554:Urination / Q000502:physiology*; D014555:Urination Disorders / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology*
keywords: bladder dysfunction; demyelinating diseases; lower uinary tract symptoms; neuromyelitis optica; urodynamics