Clinical symptoms, Urodynamic findings, and Urological treatment of 35 patients with Neurogenic Bladder Dysfunction caused by Parkinson's Disease (11 patients), Multiple Sclerosis (10 patients), and SpinoCerebellar Degeneration (14 patients) were retrospectively reviewed.

Most of the patients had a relatively low stage of disease, when they were first seen by their Urologists. Chief Urological complaints were of Irritation in 63.6% of Parkinson's Disease and 64.3% of SpinoCerebellar Degeneration cases, compared with Obstruction in 80.0% of Multiple Sclerosis cases.

Cystometry revealed underactive Detrusor function in 69.2% of the patients with SpinoCerebellar Degeneration but no abnormalities in the patients with Parkinson's Disease or Multiple Sclerosis.

Of 34 patients, excluding one patient lost to follow-up, the period of Urological management ranged from one to 44 weeks with a mean of 11.0.

The final methods of Urinary drainage in 34 patients consisted of voluntary voiding in 20, clean Intermittent Catheterization in 11 including eight by Self-Catheterization, Incontinence into diaper in two, and Indwelling Catheter in one.

Five patients were compelled to change Urinary drainage method from voluntary voiding to clean Intermittent Catheterization because of increasing residual volume in four and progressing Bladder Deformity in one. However, none of them showed the clinical signs of primary disease progression.

These findings indicate that in patients with Parkinson's Disease, Multiple Sclerosis, and SpinoCerebellar Degeneration, the Urological symptoms can appear even in the early stage of disease.

In addition, close follow-up is important in the Urological management of Neurogenic Bladder patients with these diseases, because the disorders of the lower Urinary Tract may progress regardless of the status of the primary disease.

Urodynamic study during Paroxysmal attacks revealed Uninhibited Detrusor contractions with coordinated relaxation of External Urethral Sphincter muscle.

Neurological examination and Magnetic Resonance Imaging suggested that Paroxysmal Urinary Incontinence was induced by an ectopic excitation of the DeMyelinating lesion in the right Rostral Pons.

The location of which was similar to the Pontine Micturition Center reported in previous animal experiments. Treatment with Tegretol (Carbamazepine), an AntiEpileptic drug, suppressed the attacks including the associated Urinary Incontinence.

Objectives
To detail, in a review, one institution's 6-year experience using Botulinum Toxin A (BTX-A) in the Bladder and Urethra in 110 patients for a variety of Lower Urinary Tract Disorders.

Methods
A total of 110 patients (35 men and 75 women, age range 19 to 82 years) received injections of BTX-A into the Bladder (n = 42) or urethra (n = 68).

Voiding dysfunction included Neurogenic Detrusor overactivity and/or Detrusor Sphincter Dyssynergia, Overactive Bladder, Bladder Neck Obstruction, and Interstitial Cystitis.

Under light sedation in most cases, patients were treated with either 100 to 200 U of BTX-A in 4 mL divided in equal doses into the four quadrants of the External Sphincter or by injection into the Bladder base using 100 to 300 U of BTX-A diluted in approximately 10 to 30 mL of sterile saline.

At last follow-up, 27 patients had received additional injections (up to six) at intervals of 6 months or longer.

Results
All patients who underwent Bladder BTX-A injection had preoperative evidence of involuntary Detrusor contractions during Urodynamic testing.

Analysis of the 110 patients indicated that 67.3% reported a decrease or absence of incontinence. Diaries indicated a decrease in both daytime and nighttime voiding symptoms.

Maximal efficacy occurred between 7 and 30 days and lasted for at least 6 months. Condition-specific quality-of-life symptom scores also demonstrated improvement.

No long-term complications had occurred at last follow-up.

Two women with Multiple Sclerosis and mild baseline Stress Urinary Incontinence reported increased leakage with stress after BTX-A External Sphincter injection, and one woman with Multiple Sclerosis noted new onset stress urinary incontinence after External Sphincter injection.

However, they all reported significant improvement in their Detrusor Sphincter DysSynergia with decreased postvoid residual urine volume, improved uroflow, decreased urge incontinence, and decreased daytime and nighttime frequency.

One woman with Multiple Sclerosis who underwent Bladder injection had increased postvoid residual urine volume from 78 to 155 mL. She did not have to perform intermittent catheterization.

Conclusions
BTX-A injection is a safe and promising treatment modality for a variety of Lower Urinary Tract Dysfunctions for both skeletal and smooth muscle dysfunction.

In our series, BTX-A is equally effective in women as it is in men. When injected into the Sphincter, the risk of stress incontinence is low.

Bladder injections with BTX-A are effective for not only Neurogenic Detrusor overactivity, but also overactive Bladder. BTX-A can even be considered for Interstitial Cystitis.

Purpose
We investigated the relationship of Voiding Dysfunction type and the lesion site in patients with Multiple Sclerosis.

Materials And Methods
Voiding Dysfunction was evaluated in 32 patients with Multiple Sclerosis using the International Prostate Symptom Score and Urodynamic tests.

Lesion sites were determined by combined Neurological Examination and Magnetic Resonance Imaging findings.

Results
Compared with reports from Western countries the ratio of emptying-to-filling symptoms was high in Japan. Of Urinary symptoms only filling correlated with disability status and disease duration.

Urinary symptoms were not related to lesion sites. Urodynamic evaluation revealed Detrusor Hyperreflexia in 14 of 32 patients, HypoReflexia or Areflexia in 12, Detrusor HyperReflexia with impaired contractile function in 4, a low compliance Bladder in 1 and normal function in 1.

Of 14 patients with HyperReflexia 13 had overactive Sphincter concurrently. Incompetent Sphincter was identified in 2 patients who had Detrusor HyperReflexia with impaired contractility and in 1 with a low compliance Bladder.

A significant correlation was noted for a Pontine lesion and Detrusor HypoReflexia, and for a Cervical Cord lesion and Detrusor-Sphincter DysSynergia.

Conclusions
Detrusor HypoReflexia and Detrusor-Sphincter DysSynergia are indicative of a Pontine and Cervical Spinal Cord lesion, respectively.

Thus, the lesion site in the Central Nervous System may be a major determinant of the type of Bladder and Urethral Sphincter Dysfunction.

The high prevalence of emptying symptoms in Japanese patients may reflect the prevalence of Detrusor HypoReflexia and Detrusor-Sphincter DysSynergia.

Purpose
We investigate the association of clinical and Urodynamic findings with corresponding clinical grade and possible predictors of clinical grade of Multiple Sclerosis (MS).

Materials And Methods
A total of 90 patients, 28 to 62 years old (mean age 45.8 +/- 12.1), with the clinical syndrome of MS were consecutively and prospectively studied.

All patients were subjected to detailed video urodynamic evaluation and electromyography of the external urethral sphincter.

Results
Urodynamic evaluation revealed detrusor HyperReflexia in 52 patients (57.7%), Detrusor External Sphincter DysSynergia in 27 (30%) and HypoContractility or areflexia of the Detrusor in 15 (16.6%).

Residual urine varied widely from 50 to 900 ml. Decreased compliance with areflexia was seen in 5 patients (5.5%) and nonrelaxing sphincter (but not contracting) with Bladder HyperContractility was noted in 9 (10%).

Statistical analysis followed comparison of 2 proportions.

When patients with a less severe form (grades 1 and 2) were differentiated from those with a more severe form of MS (grade 3), we observed a significant difference only in incontinence, high post-void residual, leg spasticity, urinary stones, hydronephrosis, type 3 Detrusor External Sphincter DysSynergia, no electromyography activity and positive sharp waves.

The variables with the highest predictive value between the groups were urinary stones, sepsis, type 3 Detrusor External Sphincter DysSynergia and no electromyography activity of the External Urethral Sphincter (100%).

Conclusions
Proper identification of the bladder and External Urethral Sphincter status, especially exclusion of Detrusor overactivity or a DysSynergic response of the External Urethral sphincter, will prevent complications that may result in deterioration of quality of life.