Bladder involvement in Behçet's syndrome

Is There a Correlation Between Behçet Disease and Lower Urinary Tract Symptoms?

Purpose

In this study, we aimed to determine the prevalence of lower urinary tract symptoms (LUTS) in patients with Behçet disease (BD) and to investigate the relationship between the severity of BD and LUTS.

Methods

Fifty-five patients with BD were included in this study from January to December 2018. All patients received a detailed urological evaluation. Additionally, BD activity was investigated using the Behçet Disease Current Activation Form. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire Short Form, 8-item overactive bladder questionnaire forms, uroflowmetry, and postvoid residual urine volume were evaluated.

Results

The mean age of the patients was 42.6 years. The mean activity score of BD was 4.6±3.2 and the mean IPSS score was 7.3±7.3. Sex had no significant effect on the BD activity score. The BD activity score was significantly correlated with the IPSS score, frequency of daytime urination, nocturia, and urgency. It was also correlated with the presence and the severity of urinary incontinence and the effect of urinary incontinence on daily life. Peak flow rate, voided volume, and the postvoid residual urine volume were not correlated with the BD activity score.

Conclusions

LUTS were highly prevalent in patients with BD, and the severity and current activity of BD were correlated with frequency, nocturia, urgency, and urinary incontinence. Therefore, a urological evaluation of patients with BD in whom the activity and severity of the disease is elevated should be carried out comprehensively and patients should be managed accordingly.

Parenchymal neuro-Behçet disease with erectile dysfunction and micturition disturbances: case report and literature review

Parenchymal neuro-Behçet disease (NBD) is a serious clinic condition with a sub-acute or chronic disease course that results in incapability through pyramidal tract involvement. Though well-known consequences can deter a patient's life, both urinary symptoms and sexual dysfunction are underestimated complications of NBD and closely related in timing. Here, we report the case of a young male patient with parenchymal NBD who developed urinary incontinence and erectile dysfunction in addition to widespread pyramidal tract signs and symptoms. We discuss clinical features, prognosis and treatment of the case. A review of English literature was conducted for cases of concurrent urinary or sexual dysfunction complicating parenchymal-NBD.

Urological manifestations and treatment of the primary systemic vasculitides

The primary systemic vasculitides (PSV) are a group of rare inflammatory disorders affecting blood vessels of varying size and multiple organs. Urological manifestations of PSV are uncommon. Testicular vasculitis is the most commonly reported finding and is associated with Polyarteritis Nodosa (PAN), Henoch-Schönlein Purpura (HSP), anti-neutrophil cytoplasm antibody associated Vasculitides (AAV), Giant Cell Arteritis (GCA) and Kawasaki disease. Prostatic vasculitis has been reported in association with GCA and AAV. Ureteric involvement has been noted in PAN, HSP and AAV. Other urogenital manifestations of PSV include genital ulceration and bladder dysfunction in Behçets Disease and haematuria which is commonly seen in many of the PSV. Finally, therapies used to treat the PSV, especially cyclophosphamide, are associated with urological side-effects including haemorrhagic cystitis and urothelial malignancy. The aim of this review is to examine how the urological system is involved in the PSV. Each PSV is examined in turn, with a brief clinical description of the disease followed by a description of the urological manifestations and management. Identification of urological manifestations of PSV is important as in many cases symptoms may improve with immunosuppressive therapy, avoiding the need for invasive surgery. Additionally, patients who present with isolated urogenital PSV are at higher risk of developing subsequent systemic vasculitis and will need to be followed up closely.

Ocular Behçet disease: current therapeutic approaches

PURPOSE OF REVIEW

To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD).

RECENT FINDINGS

Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME).

SUMMARY

Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.

Behçet's syndrome

Recent epidemiological work suggests that genetic background overrides environmental factors in the pathogenesis of Behçet's syndrome (BS). There are at least two clusters of disease expression. The first is the cluster of superficial vein thrombosis, deep vein thrombosis and dural sinus thrombi; the second cluster is that of acne, arthritis and enthesitis. The association of antibodies to anti-Saccharomyces cerevisiae antibodies and the presence of inflammatory bowel disease is perhaps another such cluster. The presence of such clusters suggests that there might be more than one disease mechanism operative in this complex disorder. There is a recent trend to classify BS with the autoinflammatory disorders. However, practically all autoinflammatory conditions are recurrent fever syndromes of children, and are genetically linked to well-defined loci; none of this is true for BS. Recent guidelines from the European League Against Rheumatism are quite useful for the management of the disease in organ systems other than the vascular, neurological and gastrointestinal systems, because of the lack of controlled studies related to these latter pathologies.

Which factors predict upper urinary tract deterioration in overactive neurogenic bladder dysfunction?

OBJECTIVES

To determine whether bladder histopathologic changes, detrusor leak point pressure (DLPP), disease duration, and preoperative catheterization time can predict for upper urinary tract (UUT) deterioration in patients with overactive neurogenic bladder dysfunction (ONBD).

METHODS

A total of 39 patients (7 women and 32 men) with ONBD who were treated with augmentation cystoplasty were included in the study. The patients had undergone perioperative full-thickness bladder biopsies during augmentation cystoplasty. Routine evaluation using light microscopy to investigate for inflammation, fibrosis, and mast cell count was done. Statistical analysis was done using the chi-square and Mann-Whitney U tests.

RESULTS

The mean duration of the disease was 8.7 years. Of the 39 patients, 18 (46%) had had indwelling catheters preoperatively. UUT deterioration was found in 16 (41%) of 39 patients. The mean DLPP was 105 cm H2O. The severity of detrusor fibrosis was a significant risk factor for UUT deterioration (P = 0.036). However, the degree of inflammation and the severity of fibrosis did not affect UUT deterioration. A DLPP of more than 75 cm H2O was a statistically significant risk factor (P = 0.04), but the disease duration and preoperative catheterization time were not.

CONCLUSIONS

The results of our study have shown that moderate to severe fibrosis in the detrusor and a DLPP of more than 75 cm H2O are the risk factors for UUT deterioration in patients with ONBD. However, additional studies, including ones with more patients, are needed to determine the relationship between the histopathologic changes and UUT deterioration in ONBD.

Behçet disease

Central nervous system involvement in Behçet disease (BD) may be either parenchymal or nonparenchymal. Abnormal cerebrospinal fluid findings and parenchymal involvement are associated with a poorer prognosis. A self-antigenic role for HLA B51 has been postulated in the pathogenesis of BD. The sibling occurrence rate is 3.6%. Familial aggregation may be more pronounced among pediatric cases compared with adult cases. The importance of inherited coagulation abnormalities in the pathogenesis of BD is not clear. Vasculitis of the vasa vasorum seems to be the major site of pathology in large vessel disease. Even among experts, no consensus exists regarding the optimal approach to treatment. Low-dose thalidomide is effective for the mucocutaneous lesions, but polyneuropathy complicates its prolonged use. Neurologic side effects of cyclosporine A should preclude its use in patients with central nervous system involvement except in unusual circumstances. The heightened inflammatory response of BD patients to simple trauma may lead to postoperative complications, but should not be regarded as a contraindication to surgery.

Micturitional disturbance in neuro-Behçet's syndrome

BACKGROUND

Micturitional disturbance is known to occur in neuro-Behçet's syndrome (NBS). However, its pathophysiology is uncertain and few data are available concerning urodynamic findings. We describe our findings on micturitional histories and urodynamic studies in patients with NBS.

METHODS

A history of urinary symptoms was obtained from nine patients with NBS [seven male, two female, aged 26 to 54 years; mean, 41 years]. Neurological and CT/MRI findings indicated that their lesions were located mainly in the cerebral cortex, basal ganglia, cerebellum, brainstem and the spinal cord. Symptomatic patients underwent urodynamic studies, including measurement of post-micturition residuals, urethral pressure profilometry and EMG cystometry.

RESULTS

Six of the nine patients (67%) had urinary symptoms that included diurnal urinary frequency in five, sensation of urgency in five, urge urinary incontinence in five, voiding difficulty in five and nocturnal urinary frequency in four. None had urinary retention. Urodynamic studies performed in six patients showed post-micturition residuals in five (50-180 ml), increased maximum urethral closure pressure in two, decrease in four and increase in one of bladder capacities, detrusor hyperreflexia in five, decreased bladder sensation in one, brisk bulbocavernosus reflex in four, detrusor-sphincter dyssynergia in two and neurogenic sphincter EMG in one.

CONCLUSION

Our results indicate that micturitional disturbance is not rare in patients with NBS. Supranuclear pelvic nerve dysfunction seems to be mainly responsible for the disturbance.

Neurology of systemic autoimmune disorders: a pediatric perspective

Autoimmune disorders can involve patients of any age and organs of any organ system. The central and peripheral nervous systems are frequently among the targets of these diseases. Immune dysfunction often presents in childhood or adolescence. Among the autoimmune disorders that present during childhood and adolescence, systemic lupus erythematosus, dermatomyositis, and Behcet's disease affect the nervous system with some degree of frequency. Furthermore, although juvenile rheumatoid arthritis only rarely affects the nervous system during childhood, it and its adult-onset counterpart may have profound long-term neurological consequences. Both symptomatic and pathophysiologically aimed therapies are important in the treatment of the nervous system sequelae of systemic autoimmune disorders.