NEUROGENIC BLADDER DISFUNCTION AND URODYNAMIC PROFILE IN A PATIENT WITH NEUROSARCOIDOSIS

Pubblicato da il Mar 18, 2013 in | Commenti disabilitati su NEUROGENIC BLADDER DISFUNCTION AND URODYNAMIC PROFILE IN A PATIENT WITH NEUROSARCOIDOSIS

==inizio abstract==

In November 2012 a 51-years old male patient was evaluated for neurosarcoidosis. In June 2008 he was affected by right upper and lower limbs paresthesia. Urinary function resulted normal. At cranic MRI there were found three high-T2-intensity signal lesions in white matter in semioval region. Spinal cord resulted normal. Symptoms regressed spontaneously. In 2009 it was found an interstitial lung disease that was successfully treated. In 2011 it was found an enlarged inguinal lymphnode that revealed sarcoidosis histopatologically-confirmed treated by oral administration of prednisone. In September 2012 the patient developed urge urinary incontinence and nocturnal urinary frequency (>4 times/night). Urine culture was sterile, prostate resulted slightly increased nor evidence of polyuria suggestive of hypothalamic dysfunction was found. Post-micturion residual was 40mL. Medium fill water cystometry revealed normal bladder volume at first sensation (128mL), bladder capacity of 265mL and a marked detrusor hyperreflexia. Maximum urethral closure pressure was 52 cmH2O. In workshop with neurologists we decided to repeat MRI that revealed two newly-onset lesions with high-intensity signal in frontal cortex. After therapy with oxibutinin that determined xerostomia, the patient underwent 10mg/day solifenacin succinate administration with reduction of urge urinary incontinence and nocturnal urinary frequency (2 times/night).
Neurologic involvement of sarcoidosis is very rare and there are not large series of patient with urological and urodynamic evaluation. Central lesions affecting cerebral cortex, white matter and spinal cord may be mainly responsible for the micturional disorders in patients with neurosarcoidosis concording with the hypothesis discovered in literature. As long as symptoms reduced during solifenacin succinate administration we are waiting for a stabilization of micturional disorders to repeat the urodynamic study and the cranial MRI. This case-report underlines the importance of rare disease registry to reach an adequate integrated operative algorithm for patients with rare neurogenic disorders with a phenotypic variability such as neurosarcoidosis.

==fine abstract==