Lower urinary tract dysfunction in adult patients with mitochondrial disease

Complex neurological and multisystem presentations in mitochondrial disease

Mitochondrial diseases typically involve organs highly dependent on aerobic metabolism and are often progressive with high morbidity and mortality. In the previous chapters of this book, classical mitochondrial phenotypes and syndromes are extensively described. However, these well-known clinical pictures are more the exception rather than the rule in mitochondrial medicine. In fact, more complex, unspecified, incomplete, and/or overlap clinical entities may be even more frequent, with multisystem appearance or progression. In this chapter, we describe some complex neurological presentations, as well as the multisystem manifestations of mitochondrial diseases, ranging from the brain to the other organs.

Urologic presentations and management options in pediatric mitochondrial disease

OBJECTIVE

To review the evaluation and management of urologic pathology related to mitochondiral diseases (MD) in childhood.

METHODS

A retrospective review was performed of patients with MD from 1/1/2000 - 10/8/2020 who were referred for urologic evaluation at a single childrens hospital. Clinical and demographic information was reviewed including symptomatology, urodynamic evaluation, and medical/surgical management.

RESULTS

15 patients were identified for inclusion. Median age of presentation was 5 years and median follow up was 4 years. Patients presented with numerous urologic complaints including urinary retention/incomplete emptying, incontinence, and recurrent urinary tract infection. Urodynamics demonstrated elevated median bladder capacity at 172% of expected as calculated by age. Detrusor sphincter dyssynergia (DSD) was present in 6 (50%). Progression to surgical intervention occurred in 67% at a median time of 3.5 years after initial referral. This included suprapubic tube (SPT) placement and sacral neuromodulation (SNM).

CONCLUSIONS

Patients in this study were found to have a spectrum of lower urinary tract dysfunction (LUTD) with elevated bladder capacity being common. No singular urodynamic feature prevailed although DSD was found in 50%. Progression of symptoms over time was also common. Most patients (67%) did go on to surgical intervention including SPT and SNM. Clinicians should be aware of the possibility of LUTD in children with MD and they should be promptly referred to pediatric urology when LUTD is suspected.

Prevalence and factors related to urinary incontinence in older adults women worldwide: a comprehensive systematic review and meta-analysis of observational studies

Background

Urinary incontinence is a common condition in the general population and, in particular, the older adults population, which reduces the quality of life of these people, so this study aims to systematically examine and meta-analyse the overall prevalence of urinary incontinence in older women around the world and the related and influential factors.

Methods

This report is a comprehensive systematic review and meta-analysis of the findings of research on urinary incontinence in older adults people across the world through looking for MEDLINE, Cochrane Library Sciencedirect, Embase, Scopus, ProQuest and Persian databases, namely iranmedex, magiran, and SID from January 2000 to April 2020, the heterogeneity of the experiments was measured using the I² index and the data processing was done in the Systematic Meta-Analysis programme.

Results

In 29 studies and the sample size of 518,465 people in the age range of 55–106 years, urinary incontinence in older adults’ women in the world based on a meta-analysis of 37.1% (95% CI: 29.6–45.4%) was obtained. The highest prevalence of urinary incontinence was reported in older adults’ women in Asia with 45.1% (95% CI: 36.9–53.5%). Meta-regression also showed that with increasing the sample size and year of the study, the overall prevalence of urinary incontinence in the older adults women of the world decreased and increased, respectively, which were statistically significant differences (P <  0.05). According to studies, the most important factors influencing the incidence of urinary incontinence in older women are women’s age (p <  0.001), obesity (p <  0.001), diabetes (p <  0.001), women’s education (p <  0.001), delivery rank (p <  0.001), hypertension (p <  0.001), smoking (p <  0.001). They also have urinary tract infections (p <  0.001).

Conclusion

Given the high prevalence of urinary incontinence in older women around the world, health policy makers must consider control and diagnostic measures in older women and prioritize treatment and rehabilitation activities.