What is the role of Shy-Drager syndrome in the etiology of neurogenic bladder?

Updated: Dec 06, 2018
  • Author: Bradley C Gill, MD, MS; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Answer

Shy-Drager syndrome is a rare, progressive, and degenerative disease affecting the autonomic nervous system with multisystem organ atrophy. In addition to parkinsonlike symptoms, patients often exhibit cerebellar ataxia and autonomic dysfunction. Clinical manifestations include orthostatic hypotension, anhidrosis, and urinary incontinence.

Degeneration of the nucleus of Onuf results in denervation of the external striated sphincter. Sympathetic nerve atrophy causes nonfunctional bladder and an open bladder neck.

Urodynamic evaluation often reveals detrusor hyperreflexia, although a few patients may have detrusor areflexia or poorly sustained bladder contractions. Often, the bladder neck (internal sphincter) will be open at rest, with striated sphincter denervation.

The treatment for Shy-Drager syndrome is to facilitate urinary storage with anticholinergic agents coupled with CIC or indwelling catheter. Patients with Shy-Drager syndrome should avoid undergoing TURP because the risk of total incontinence is high.


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