title: Lower urinary tract dysfunction in patients with dysautonomia.
abstract: OBJECTIVE
  With the goal of better defining the types of bladder dysfunction observed in this population, we present the chief urologic complaints, results of urodynamic studies, and treatments of patients with dysautonomia-related urinary symptoms.
  
  
  METHODS
  All patients with dysautonomia referred to our neurourology clinic between 2005 and 2015 for management of lower urinary tract dysfunction were retrospectively reviewed. Each patient's chief urologic complaint was recorded and used to initially characterize the bladder storage or voiding symptoms. Patient evaluation included history and physical examination, urinalysis, post void bladder ultrasound, and urodynamic studies. Successful treatment modalities that subjectively or objectively improved symptoms were recorded.
  
  
  RESULTS
  Of 815 patients with the diagnosis of dysautonomia, 82 (10 %) were referred for evaluation of lower urinary tract dysfunction. Mean age was 47 years (range 12-83) and 84 % were female. The chief complaint was urinary urgency ± incontinence in 61 % and hesitancy in 23 % of patients. Urodynamic findings demonstrated detrusor overactivity ± incontinence in 50 % of patients, although chief complaint did not reliably predict objective findings. Successful objective and subjective treatments were multimodal and typically non-operative.
  
  
  CONCLUSIONS
  Lower urinary tract dysfunction may develop in at least 10 % of patients with dysautonomia, predominantly females. Bladder storage or voiding complaints do not reliably predict urodynamic findings. Urodynamically, most patients exhibited detrusor overactivity. The majority of patients were successfully managed with medical or physical therapy.
authors.affiliation: Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Melissa St
authors.initials: MS
authors.lastname: Aubin
authors.affiliation: Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Shridharani
authors.affiliation: Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Alexandru C
authors.initials: AC
authors.lastname: Barboi
authors.affiliation: Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Guralnick
authors.affiliation: Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Safwan S
authors.initials: SS
authors.lastname: Jaradeh
authors.affiliation: Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Prieto
authors.affiliation: Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA. CoreyOC@aol.com.
authors.forename: R Corey
authors.initials: RC
authors.lastname: O'Connor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054969:Primary Dysautonomias / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D014551:Urinary Tract / Q000503:physiopathology; D014555:Urination Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D014570:Urologic Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D055815:Young Adult
keywords: Dysautonomia; Lower urinary tract dysfunction; Treatment