Background: The micturition reflex is under the tonic influence of suprapontine structures including the anteromedial frontal cortex, basal ganglia, and hypothalamus. However, there have been few reports about the role of the hypothalamus on the lower urinary tract (LUT) function in humans. Objective: To investigate LUT function in patients with pituitary adenomas. Methods: Urodynamic studies were carried out in three patients with LUT symptoms who had pituitary adenomas extending upwards to the hypothalamus. Results: All three male patients (age 28 to 62 years) developed LUT symptoms (urinary urgency and frequency (3); urinary incontinence (3); voiding difficulty and retention (2)) along with weight loss, psychiatric symptoms, unsteady gait, and/or visual disturbances. One had the syndrome of inappropriate secretion of antidiuretic hormone, but none had diabetes insipidus. Two had resection of the tumour and subsequent radiation therapy, but LUT dysfunction persisted. The third patient had partial resection of the tumour to ameliorate hydrocephalus. Urodynamic studies showed detrusor overactivity during the storage phase in all patients; during the voiding phase there was underactive detrusor in two and non-relaxing sphincter in one. Conclusions: Hypothalamic lesions can cause severe LUT dysfunction in both the storage and voiding phases of micturition. This may reflect the crucial role of the hypothalamus in regulating micturition in humans.
Bowel dysfunction is a common problem in patients with metabolic/neurological disorders and ranges from constipation and intestinal pseudo-obstruction to intractable fecal incontinence. However, the mechanism of it remains not entirely clear, although the bowel dysfunction severely affects the quality of life in the patients.
Here, we report on a 32-year-old man with clinically diagnosed Wolfram syndrome (WFS), which is thought to be caused by a WFS1 gene mutation that encodes wolframin , an endoplasmic reticulum calcium channel in neurons and pancreatic β-cells. He also presented with severe …
This chapter review summarized the epidemiology, pathophysiology, and management of bladder dysfunction in patients with multiple system atrophy (MSA). Since motor disorders in MSA often mimic those in Parkinson's disease (PD), the different bladder disorders between these two diseases are worth considering; the identification of the specific bladder disorder aids the differential diagnosis of MSA, PD, and other MSA mimics. A bladder disorder is often the sole initial manifestation of MSA, and such patients see urologists or physicians first. Difficult emptying in MSA needs particular care at a neurology clinic. The collaboration of neurologists and urologists is highly recommended for the improvements of patients' quality of life.
