URODYNAMIC STUDY OF LOWER URINARY TRACT

X. Four Cases of Neurogenic Bladder Dysfunction due to Tabes Dorsalis

Abstract

Neurogenic bladder dysfunction caused by tabes dorsalis (tabetic bladder) was found in 4 patients, 3 males and 1 female, aged from 57 to 67. The chief complaint comprised difficulty in urination, retention and/or incontinence. Serological test for syphilis was positive in the all cases. The flaccid anal tonus was found in 3 and the bulbocavernous reflex was negative in 3. Cystometric examination revealed an autonomous bladder in 2 and a hypotonic bladder in 2. The former responded to the denervation supersensitivity test (Lapides-Glahn test) but the latter did not. The maximum urethral pressure was found decreased by urethral pressure profile, which was characteristic of the tabetic bladder.
Intermittent self-catheterization was of effect in the all cases as a conservative method of treatment. Transurethral resection of the bladder neck was attempted in 1 case to reduce residual urine further. 2 patients died of meningovascular syphilis 4 years and 2 weeks, respectively, after the first visit to our clinic. In summary, tabetic bladder dysfunction is based upon the impairment of bladder sensory and motor nerves, which, in turn, prevents the synergitic movement of the detrusor and sphincter muscles.