Abstract
To describe urodynamic abnormalities in HTLV-1 infected individuals presenting urinary symptoms and verify if these findings and quality of life (QOL) evaluation correlate with overall neurological impairment. From January/2001 to May/2004, 324 HTLV-1 seropositive subjects were evaluated to determine the occurrence of urinary symptoms. Urodynamic testing was performed in those who complained of frequency, urgency, or incontinence. They went through a complete clinical, neurological, and urological examination to investigate symptoms and signs of myelopathy. Neurological disability was assessed by Expanded Disability Status Scale (EDSS). From the 324 patients evaluated, 78 underwent the urodynamic testing. Fifty-seven individuals were females (73.1%) and age ranged from 23 to 76 years (mean=48.7 years; SD +/- 11.6). Urodynamic testing was abnormal in 63 patients (80.8%). The major abnormality was detrusor overactivity (DO), observed in 33 individuals (33/63; 52.4%), followed by detrusor-external sphincter dyssynergia (DESD), diagnosed in 15 subjects (15/63; 25.4%). HAM/TSP patients had significantly more DESD than the HTLV-I carriers (p=0.005; OR=5.5; CI: 1.6 to 19.4). QOL was severely compromised in HAM/TSP patients. Prominent urodynamic abnormalities were identified in individuals genuinely considered as HTLV-I carriers, suggesting an early compromise of the urinary tract; whereas HAM/TSP patients presented urodynamic findings, which posed a potential risk to the upper urinary tract (dyssynergia). Urodynamic evaluation should be performed in all HTLV-I-infected individuals with voiding complaints.
Highlights
Human T-cell lymphotropic virus type I (HTLV-1) is a retrovirus that infects about 10 to 20 million people worldwide with endemic foci in Southern Japan, the Caribbean, Central and South Africa, and South America [1]
Patients were divided into 2 groups: HTLV-I carriers, composed of individuals who did not fulfill the criteria for HTLV-I-associated myelopathy (EDSS < 3), and HTLV-I-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) patients who had Expanded Disability Status Scale (EDSS) ≥ 3
The present study describes the urodynamic findings in HTLV-I-positive individuals, according to EDSS classification and urinary symptoms
Summary
Human T-cell lymphotropic virus type I (HTLV-1) is a retrovirus that infects about 10 to 20 million people worldwide with endemic foci in Southern Japan, the Caribbean, Central and South Africa, and South America [1]. About 5% of HTLV-I infected individuals develop either adult T-cell leukemia (ATL) or a chronic inflammatory disease of the central nervous system. The association between HTLV-I infection and tropical spastic paraparesis was first made in 1985 [3]. An independent work in Japan found an HTLV-I Infection and Urodynamic Findings association between HTLV-I and myelopathy in 1986 [4]. In 1989 the World Health Organization designated the term HTLV-I-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) for the neurological syndrome associated to this virus. HAM/TSP is a chronic and slowly progressive inflammatory myelopathy that may lead to severe neurological disability [5]
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