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Bladder dysfunction in hereditary spastic paraplegia: what to expect?
  1. Mark Braschinsky1,
  2. Inga Zopp2,
  3. Mart Kals3,
  4. Sulev Haldre1,
  5. Katrin Gross-Paju2
  1. 1Department of Neurology, University of Tartu, Tartu, Estonia
  2. 2Centre for Neurological Diseases, West Tallinn Central Hospital, Tallinn, Estonia
  3. 3Department of Mathematics, University of Tartu, Tartu, Estonia
  1. Correspondence to Dr M Braschinsky, Department of Neurology, University of Tartu, Puusepa 2, Tartu 51014, Estonia; mark.braschinsky{at}


Background Hereditary spastic paraplegia (HSP) comprises a group of rare neurodegenerative disorders characterised by progressive spasticity and hyperreflexia of the legs. Neurogenic bladder dysfunction is a well recognised problem in patients with HSP but it has not yet been described systematically in the literature. The aim of this study was to provide an evidential overview of the ways in which urinary dysfunction presents in HSP.

Methods 49 patients with HSP were included and underwent evaluation. A history was followed by a semi-structured interview and, in those patients who consented, measurement of residual volume of urine (PVR) and urodynamic evaluation.

Results 38 subjects (77.6%) reported some type of urinary symptom. Subjective complaints of bladder problems showed a correlation with verified urinary dysfunction. There were no significant differences in the occurrence of urinary disturbances between the pure and complex forms of HSP. The most frequent symptoms were incontinence (69.4%), hesitancy (59.2%), increased frequency of micturition (55.1%) and urgency (51.0%). Incomplete bladder emptying was the rarest (36.7%). The most common combination of symptoms was to have all of them (14.3%). Incomplete bladder emptying as a complaint was associated with an increased risk of PVR. Women had a higher risk of increased voiding frequency.

Conclusions To our knowledge, this work is the first systematic and disease oriented overview of neurogenic bladder disturbances in patients with HSP. Our results may be useful to the clinicians who work with HSP patients, allowing them to make appropriate screening and management decisions.

  • Heredit spastic paraplegia
  • neurogenic bladder

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  • Funding This study was funded by the Estonian Science Foundation (Endla 4, Tallinn 10142, Estonia), research grant No ETF5680.

  • Competing interests None.

  • Ethics approval This study was approved by the Ethics Review Committee on Human Research of the University of Tartu (Ülikooli 18-304, Tartu 50090, Estonia).

  • Provenance and peer review Not commissioned; externally peer reviewed