[Lower urinary tract dysfunction in normal pressure hydrocephalus: Review of the literature].
BACKGROUND
Lower urinary tract dysfunction in normal pressure hydrocephalus has received little attention from the scientific community. The aim of this review article was to discuss diagnostic and therapeutic options for these patients.


METHODS
A literature review of MedLine publications on urinary incontinence in normal pressure hydrocephalus was conducted. The following keywords were used: "hydrocephalus, normal pressure" and "bladder dysfunction" or "urinary incontinence" or "overactive bladder" or "urinary bladder, neurogenic". Prospective and retrospective studies as well as previous reviews were analyzed.


RESULTS
Urinary symptoms in normal pressure hydrocephalus are mainly represented by overactive bladder, which is a significant burden for the concerned patients. Isolated overactive bladder is more frequent (64%) than urinary incontinence (57%). Detrusor overactivity is seen in 95.2% of the cases. Neuro-surgery is efficient on urinary symptoms for 61.5% of the patients. Bladder recovery after surgery relates with increased mid-cingulate perfusion, probably linked with a functional restoration of the mid-cingulate that normally inhibits the micturition reflex. Medical options, added or not to surgery, include anticholinergic drugs unable to pass through the blood-brain barrier, Transcutaneous Electrical Nerve Stimulation and sacral neuromodulation.


CONCLUSIONS
There is actually an insufficient concern about urinary symptoms in normal pressure hydrocephalus. This article highlights the importance of a harmonization of neuro-urological practices in the pre-therapeutic evaluation of patients suffering from normal pressure hydrocephalus.
Département de chirurgie urologique, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France. Electronic address: elsa.bey88@gmail.com.
E
E
Bey
Département de neuro-chirurgie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
B
B
Nicot
Département de neurologie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
O
O
Casez
Département de chirurgie urologique, CHU de Nantes, 85, rue Saint-Jacques, Nantes, France.
L
L
Le Normand
D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000150:complications*; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000209:etiology*
Hydrocéphalie chronique de l’adulte; Hydrocéphalie à pression normale; Hyperactivité vésicale; Incontinence urinaire; Lower urinary tract dysfunction; Normal pressure hydrocephalus; Overactive bladder; Troubles vésico-sphinctériens; Urinary incontinence