Bladder dysfunction in subacute combined degeneration

Abstract

In view of the paucity of studies on micturition disturbance in subacute combined degeneration (SACD), this prospective study reports micturition disturbance in SACD and correlations with urodynamic and MRI findings. SACD was diagnosed by clinical features and low serum B12 level (< 211 pg/ml) and/or megaloblastic bone marrow. Micturition disturbances were categorized into voiding and storage symptoms and scored using the American Urological Association Symptoms (AUAS) score. Spinal MRI and urodynamic studies were carried out. Patients were treated with vitamin B12 1000 microg daily i.m. and outcome was defined at 6 months into complete, partial and poor. Eight patients with SACD aged 53.8 (44-70) years were included; 2 of whom were females. The mean duration of illness was 2.2 (1-120) months. All had walking difficulty, 2 were wheelchair bound and 4 bedridden. Lower limb spasticity and joint position impairment were present in all; ankle reflex was absent and pinprick sensation reduced distally in 4 patients each. T2 hyperintensity in the posterior spinal cord was present in 5 and in subcortical white matter in 2 patients. Five patients had storage, 7 voiding and 4 had both dysfunctions. AUAS score was 14.63 (4-35). On urodynamic study, detrusor areflexia was present in 2, neurogenic detrusor overactivity with high pressure voiding in 3 and normal in 2 patients. The urinary symptoms improved in all (AUAS score 3.67). Repeat urodynamic study in 2 patients, who had detrusor areflexia improved. At 6 mo, 3 patients had complete, 4 partial and 1 poor recovery. Bladder symptoms occur in advanced cases of SACD; both detrusor areflexia and neurogenic detrusor overactivity with high pressure voiding occur and respond to B12 therapy.