Dados do Trabalho

Título

Assessing urodynamic status and renal function in HTLV-1-associated myelopathy/tropical spastic paraparesis in a Brazilian rehabilitation reference centre

Introdução

HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is associated with neurogenic bladder. CAAE:73714623500000022      

Objetivo (s)

To describe the urodynamic status and renal function of patients with HAM/TSP.

Material e Métodos

A case series was carried out. From 130 patients, 108 underwent urodynamic evaluation; 120 had at least one cystatin-C dosage for glomerular filtration rate (GFR) calculation.    

Resultados e Conclusão

Urinary Symptoms: frequency(39.0%), urgency (88,5%), incontinence (87,6%), nocturia (73.3%), intermittent jet (62.8%), incomplete emptying 72 (68.6%), straining to urinate (65,7%). Bladder compliance was decreased in 6 patients (5.8%). Bladder capacity was <250mL in 20.4% and >450mL in 44.4%; 32.4% had a flaccid bladder and 69.4% had an overactive bladder (OB); maximun detrusor pressure at cystometry (MDPC) was ≤ 40cmH20 in 41.3%, and >41 cmH20 in 58.7%; 92.4% had a residual volume >50mL and 83% had a volume >100mL; 51.2% were classified as having infravesical obstruction (IVO). Cystatin C-estimate glomerular filtration rate (e-GFRcys) was <60 mL/min/1.73m2 in at least one assessment, in 30% of the patients. In 80 patients who had more than one dosage, the mean reduction in e-GFRcys was 18% between the first and last. Among 114 patients undergoing urinary US, 19.3% patients had hydronephrosis, and 8.8% had urolithiasis. From 87 patients undergoing cystourethrography, 11.5% presented vesicoureteral reflux. For better describing this case series, considering as an outcome the presence of at least one eGFRcys<60mL/min/1.73m2, no association was observed with the presence of OB (OR=0.87; 95%CI=0.35-2.14; p=0.817), IVO (OR=0.77; 95%CI=0.29-2.03; p=0.630), flaccid bladder (OR=1.85; 95%CI= 0.77-4.44; p=0.176), vesicoureteral reflux (OR=0.94, 95% CI=0.22- 3.97; p=1.00) or hydronephrosis (OR=2.29; 95%CI= 0.88-5.98; p=0.087). However, this outcome was associated with MDPC <40cmH20 (OR=3.44; 95%CI=1.20-9.86; p=0.034). Considering the average reduction in e-GFRcys between the first and last measurement, there was also no association with these parameters. Considering hydronephrosis, there was no correlation with MDPC (OR=1.75; 95% CI=0.56-5.38), OB (OR=2.90 95% CI=0.78-10.79), flaccid bladder OR=0.68 95% CI=0.22-2.10) and IVO (OR=0.47 95% CI=0.14-1.61). Monitoring urodynamic status is important in HAM/TSP for diagnosis and treatment monitoring, but the progressive impairment of renal function, which is common, does not seem to have urodynamic parameters as strong predictor.

Palavras Chave

HTLV-1; HAM/TSP; NEUROGENIC BLADDER; URODYNAMIC; KIDNEY INJURY