ABSTRACT

With the exploration of penicillin, incidents of syphilis, which swept the Europe during the 16th century, decreased after 1940. Neurogen bladder arising from neurosyphilis was seen frequently before the penicillin period. We aimed to share a patient who has this rarely seen association. A 46-year-old male patient was admitted to a neurology clinic because of convulsion, dementia, and incontinence. No lesion determined in brain at magnetic resonance study. In the cerebrospinal fluid investigation, an increase in the number of leukocytes with lymphocytes and amount of protein was determined. Based on high positive treponema palladium hemagglutination assay (TPHA) test in the cerebrospinal fluid and blood, the presence of suspect sexual intercourse history, and occurrence of eruption on hands and feet that cleared up 10 years ago, a neurosyphilis diagnosis was made, and 6x4 M IU/d units iv penicillin treatment was applied for 21 days. After the completion of the patient’s treatment in the neurology clinic, further examination was decided, because it was thought that neurogen bladder arising from neurosyphilis might develop because of the presence of urinary incontinence and pollakiuria complaints. At the beginning, uroflowmetry was worked to be done; however, the patient could not make enough (at least 150 mL) micturation. Thereupon, we decided to do filling cystometry and pressure-flow study. It was seen in the ultrasonography that bladder volume was 500 mL, thickness of the bladder wall was at normal level, prostate volume was 20 cc, and kidneys were bilaterally normal. It was seen that residual urine was approximately 400 cc after micturition. In filling cystometry, it was seen that maximum bladder capacity before the overflow incontinence was 490 mL. It was seen that the first urinary feeling occurred at 350 mL of volume and 26 cm H2O of pressure; first urge to void feeling occurred at 460 mL volume and 35 cm pressure. It was seen that sense of bladder started to get damaged; however, the sense was not completely gone yet. It was seen that intra-vesicular pressure increased at 300 mL of volume and was more than 40 cm H2O of pressure at end of study. It was decided that the bladder compliance was 12.4 mL/cm H2O and that there was a medium-level loss of compliance. It was seen at the pressure- flow study that the patient who was encouraged to micturate for 2 minutes could only micturate by increasing intra-abdominal pressure, and detrusor pressure did not increase. As is, a hyposensitive and acontractile bladder diagnosis was made. It was thought that aseptic intermittent catheterization (AIC) and oral anticholinergic treatment were appropriate for the patient. Neurosyphilis is a rarely seen disease nowadays. Neurogen bladder arising from neurosyphilis is much rare in urology practices. When encountering a patient with this disease, urodynamic assessment should be done in order to have an idea about bladder functions; a choice should be made among bladder neck resection, urinary diversion and AIC. (JAREM 2014; 1: 38-40)

Keywords: Neurosyphilis, neurogenic bladder, urodynamic study in neurosyphilis