Relationship between clinical and urodynamic findings in HTLV-1-infected patients with HAM/TSP

Abstract

Background: Human T-lymphocyte virus type-1 (HTLV-1) infection and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) are endemic in the northeastern population of Iran. Urologic manifestations of the syndrome are different in various stages of HAM and should be evaluated via urodynamic study. The northeastern region of Iran is among the endemic areas; therefore, a comprehensive study is needed to investigate the clinical symptoms and urodynamic findings of these patients. Methods: In this study, we examined the clinical features and urodynamic findings of 50 HAM/TSP patientswhoreferred to the urology clinic of Imam Reza Hospital in Mashhad. Data were collected using checklists and analyzed by SPSS software. The significance level of 0.05 was used in all statistical tests. Results: Among 50 patients, 27 (54%) were female. The mean age was 57.56 ± 11 years. The most common clinical findings in patients were urinary frequency (88%), followed by urgency (86%). In addition, the most common urodynamic finding was detrusor overactivity (DO; 78%). Among the studied patients, 62% had pain in the low back or lower extremities, 10% had detrusor sphincter dyssynergia (DSD), 66% had a kind of sensory abnormality, 46% had urinary incontinence, 4% had retention, and 34% had no clinical signs. Regarding neurological symptoms, 36% had rigidity and 28% had an abnormal gait. There was a significant relationship between abnormal gait and DO, DSD, urodynamic incontinence, and decreased urinary compliance (P = 0.01, 0.02, 0.009, and 0.002, respectively). Conclusions: We found that neurologic symptoms and lower urinary tract symptoms (LUTS) do not always synchronize and LUTS may be related to neurologic symptoms. Therefore, urinary and urodynamic evaluations must be performed in the first step for HAM/TSP patients. Among LUTS, only was urinary urgency related to urodynamic findings. Neurologic symptoms were significantly associated with DSD and thus, they can alarm for upper urinary tract damage.