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Tumors of the Spine, Intervertebral Disk Prolapse, the Cauda Equina Syndrome
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Patrick J. Shenot, M. Louis Moy
Compression of nerve roots will typically result in lower back pain and pain that radiates along the dermatomes of the affected nerve roots. Most patients with symptomatic lumbar disk prolapse are initially managed medically, and only a minority will have clinical signs and symptoms of bladder dysfunction. Patients with urologic symptoms will usually complain of urinary hesitancy and intermittency, straining to urinate, and sometimes a sensation of incomplete bladder emptying. Incontinence is much less common and implies a more severe insult resulting in overflow incontinence, sphincteric dysfunction from pelvic floor denervation, or a combination of both processes.
Antipsychotics: Predicting Response/Maximizing Efficacy
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
R. Bruce Lydiard, John S. Carman, Mark S. Gold
Distressing but rarely serious genitourinary effects can occur with antipsychotic treatment (Table 13). Urinary hesitancy is common in the elderly, and especially in males with enlarged prostates. Urinary retention may rarely occur. Using low-anticholinergic agents may be helpful in minimizing this effect. Urecholine® (10 to 25 mg t.i.d.) may help counteract the peripheral anticholinergic effects. Impaired erection or ejaculatory dysfunction (impaired, delayed, or retrograde ejaculation) in males can be an extremely distressing problem and is most often associated with thioridazine.240,241 Priapism may also be a rare side effect of the phenothiazines.242 Since patients are often embarrassed to volunteer information about sexual difficulties, they should be questioned specifically about this. These are often ameliorated by switching to another agent and reassuring the patient.
Intervertebral disk prolapse
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Patrick J. Shenot, M. Louis Moy
Compression of nerve roots will typically result in lower back pain and pain that radiates along the lumbar dermatomes of the affected nerve roots.19 The true incidence of lower urinary tract dysfunction in patients with disk prolapse is unknown. It is important to remember that most patients with lumbar disk prolapse do not have the cauda equina syndrome or progressive weaknesses are initially managed medically. A distinct minority of patients presenting with lumbar disk protrusion will have clinical signs and symptoms of bladder dysfunctions. Many reported series on this subject describe findings only in patients who present with urologic symptoms. Multiple studies indicate that the patient will usually complain of urinary hesitancy and intermittency, straining to urinate, and sometimes a sensation of incomplete bladder emptying. Incontinence is much less common and implies a more severe insult resulting in diminished bladder sensation resulting in overflow incontinence, sphincteric dysfunction from pelvic floor denervation, or a combination of both processes.
Association of the inflammatory potential of diet and lower urinary tract symptoms among men in the United States
Published in The Aging Male, 2021
Xinyang Liao, Haiyang Bian, Xiaonan Zheng, Jianzhong Ai, Lu Yang, Liangren Liu, Shi Qiu, Qiang Wei
Besides, we extracted covariates from the NHANES database, including age, 24-h energy intake, race, body mass index (BMI), smoking history, alcohol consumption, and Charlson comorbidity index [21], the sum of weights of patients’ comorbidities. LUTS was accessed in NHANES by four questions, which included (1) How often have urinary leakage? This question asked about urinary frequency (Question number: KIQ005), (2) Usually have trouble trying to urinate? This question asked about urinary hesitancy (Question number: KIQ081), (3) After urinating, does bladder feel empty? This question asked about incomplete emptying (Question number: KIQ101), and (4) How many times urinate in the night? Nocturia was defined as two or more nightly voids (Question number: KIQ480). This study’s outcome, clinical LUTS, was defined as two or more than two above-mentioned LUTS, as per Fantus et al. [22].
Giant intradural extramedullary spinal ependymoma, a rare arachnoiditis-mimicking condition: case report and literature review
Published in British Journal of Neurosurgery, 2023
Nicolò Marchesini, Christian Soda, Umberto Maria Ricci, Giampietro Pinna, Franco Alessandrini, Claudio Ghimenton, Riccardo Bernasconi, Gaetano Paolino, Marco Teli
In 2015, a 23-year-old male patient presented to our Department complaining of progressive paraparesis, lower limb numbness and urinary hesitancy for 1 week. His past medical history was unremarkable. Neurological examination revealed lower limb weakness (4/5 MRC) and a sensory level below the umbilical line. Pyramidal signs were present and he could not walk independently. Anal tone was lower than normal. All blood tests were within the normal ranges. A spinal MRI showed a peri-medullary, posterior multi-cystic dilatation extended between T1 and T12. Post-contrast sequences showed peri-medullary leptomeningeal enhancement and an initial diagnosis of spinal arachnoiditis was formulated (Figure 1). A brain MRI was negative. 2 weeks after the symptoms had begun, the patient underwent a T2-T12 laminotomy and longitudinal durotomy. The spinal cord appeared circumferentially wrapped by a greyish and irregular tissue. On manipulation, it appeared soft and a clear cleavage plan was seen throughout almost the whole extension of the affected the spinal cord. Most of the material was removed but some parts were left in place due to their anterior, inaccessible location (Figure 2). Resection was judged incomplete. Histology was in keeping with ependymoma WHO grade II (Figure 3). The patient was discharged 14 days after surgery. A few days later a wound infection occurred and an MRI revealed a fluid collection between T3 and T10. The patient underwent a successful revision surgery with subsequent eradication of the infection (Enterobacter aerogenes was isolated and Meropenem was administered). After intensive rehabilitation, he completely recovered his motor function, but a mild urinary urgency persisted. At the six months follow-up MRI a residue was seen at T2-T3 in association with post-operative arachnoid webs (Figure 4(A)). At the 2.5 years follow up MRI the residue at the level of T2-T3 was stable (Figure 4(B)) but the laminae were almost completely reabsorbed and kyphosis had increased compared to preoperatively (Figure 4(C–D)). The patient currently conducts a nearly normal life but complains of mild urinary urgency.