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Biomedical subjects

Ryuji Sakakibara

Publications and source records attributed to Ryuji Sakakibara.

At least 19 recordsLinked to original sources
PubMed2007

Urinary retention and sympathetic sphincter obstruction in axonal Guillain-Barré syndrome.

A 62-year-old woman with axonal Guillain-Barré syndrome developed weakness and urinary retention simultaneously. The retention failed to recover for 10 months even after she regained the ability to walk. The patient exhibited no postural hypotension. Videourodynamics showed that the retention was caused not by the bladder paralysis but rather by internal (sympathetic) sphincter obstruction, which is extremely uncommon in peripheral neuropathies. We started the patient on an alpha-adrenergic antagonist, urapidil, at 30 mg/day, and this led to successful relaxation of the urethra and reduced the postvoid residual from 200 ml to less than 30 ml. The underlying mechanisms of urinary retention in our patient appeared to involve hyperactive lumbosacral sympathetic nerves. Urinary retention and sympathetic sphincter obstruction can thus be features of axonal Guillain-Barré syndrome.

Adrenergic alpha-Antagonists↗
PubMed2006

Mechanism of constipation in familial amyloid polyneuropathy: a case report.

Previously no functional study has been available for the mechanism of constipation in familial amyloid polyneuropathy (FAP). We performed a gut function test in a 78-year-old woman with transthyretin-type FAP who had severe constipation. The gut function test showed a prolonged colonic transit time, a low anal pressure at rest and upon squeezing, loss of the spontaneous phasic rectal contractions, and weak abdominal strain. All these abnormalities suggested a peripheral autonomic dysfunction, corresponding to the enteric neuropathy that was confirmed upon autopsy.

Aged↗
PubMed2006

Aseptic meningoencephalitis presenting with bilateral vestibular ataxia: a case report.

Bilateral vestibular dysfunction is a rare condition, of which peripheral disorders are most common, whereas central disorders are extremely rare. A 35-year-old woman developed fever, headache, dizziness, convulsion, and disturbance of consciousness at the same time. MRI findings were normal. Based on the neurological findings and laboratory abnormalities, she was diagnosed as having aseptic meningoencephalitis. Steroid pulse therapy successfully ameliorated her encephalitis sign. However, isolated bilateral vestibular ataxia and dizziness, together with severe decrease of Caloric nystagmus, became apparent and lasted for the following 3 months, without cerebellar/brainstem involvement.

Adult↗
PubMed2006

Acute urinary retention due to benign inflammatory nervous diseases.

Both neurologists and urologists might encounter patients with acute urinary retention due to benign inflammatory nervous diseases. Based on the mechanism of urinary retention, these disorders can be divided into two subgroups: disorders of the peripheral nervous system (e.g., sacral herpes) or the central nervous system (e.g., meningitis-retention syndrome [MRS]). Laboratory abnormalities include increased herpes virus titers in sacral herpes, and increased myelin basic protein in the cerebrospinal fluid (CSF) in some cases with MRS. Urodynamic abnormality in both conditions is detrusor areflexia; the putative mechanism of it is direct involvement of the pelvic nerves in sacral herpes; and acute spinal shock in MRS. There are few cases with CSF abnormality alone. Although these cases have a benign course, management of the acute urinary retention is necessary to avoid bladder injury due to overdistension. Clinical features of sacral herpes or MRS differ markedly from those of the original "Elsberg syndrome" cases.

Acute Disease↗
PubMed2006

Incomplete emptying and urinary retention in multiple-system atrophy: when does it occur and how do we manage it?

Neurogenic urinary retention can be a major cause of morbidity in multiple-system atrophy (MSA). However, the timing of its appearance has not been entirely clear, and neither have the medical and surgical modalities for managing patients. We present the data obtained from our uroneurological assessment and therapeutic interventions at various stages of MSA. We recruited 245 patients with probable MSA. We measured postvoid residuals (PVR) and performed EMG cystometry in all patients. The grand average volume of PVR was 140 mL (range, 0-760) in our patients. The average PVR volume was 71 mL in the first year, increasing to 129 mL in the second year and 170 mL by the fifth year. The percentages of patients with complete urinary retention, acontractile detrusor, and detrusor-sphincter dyssynergia (DSD) also increased. The increase in PVR resulted in a decrease in functional bladder capacity, together with an increase in detrusor overactivity and neurogenic sphincter EMG. Clean intermittent self-catheterization (CISC) was introduced in most patients. Bladder-oriented therapy (cholinergic agents) had a limited value, whereas urethra-oriented therapy benefited patients with DSD (surgery) for up to 2 years, but syncope occurred in a subset of patients (alpha-blockers). MSA patients present with large PVR by the second year of illness, and that large PVR secondarily causes urinary frequency. CISC is the recommended treatment for most patients. Urethra-oriented medication and surgery benefit patients who would have difficulty performing CISC, although careful consideration of the short-term efficacy and potential adverse effects of these alternatives is mandatory.

Adrenergic alpha-Antagonists↗
PubMed2006

Neurological diseases that cause detrusor hyperactivity with impaired contractile function.

AIMS: Detrusor hyperactivity with impaired contractile function (DHIC) was originally described in elderly women. It has not previously been well known whether neurological diseases cause DHIC. We investigated which neurological diseases commonly cause DHIC in our laboratory. MATERIALS AND METHODS: We searched for DHIC in our laboratory's computerized database of 1,514 case records, which included a lower urinary tract (LUT) symptom questionnaire and urodynamic study results. DHIC was defined as the presence of both (1) detrusor overactivity during the storage phase, and (2) underactive detrusor contraction during the evacuation phase. RESULTS: Two hundred and seventeen patients met the criteria for DHIC: 122 men and 95 women; mean age, 63 years. The neurological diseases that caused DHIC included Parkinsonian syndrome (18%), multiple system atrophy (18%), progressive supranuclear palsy/corticobasal degeneration (14%), multiple cerebral infarction (MCI) (12%), multiple sclerosis/acute disseminated encephalomyelitis (18%), spinal cord lesions (15%), and cervical spondylotic myelopathy (CS) (10%). CONCLUSIONS: The present study revealed that a wide spectrum of neurological disorders could cause DHIC.

Adult↗
PubMed2006

Bladder sensation in peripheral nerve lesions.

OBJECTIVE: To present bladder sensory data of three common peripheral nerve lesions (e.g., distal, intermediate/focal, and proximal). METHODS: We measured first sensation (FS) and bladder capacity (BC) (not exceeding 600 ml) in 71 patients with peripheral nerve lesions: 35 diabetic neuropathy (D group), 6 post-pelvic surgery (S), and 27 cauda equina syndrome due to lumbar spondylosis (L). We excluded those with detrusor overactivity or low compliance that might affect bladder sensation. RESULTS: The mean FS was 301.7 ml (D), 271.3 ml (S), and 189.4 ml (L), with the largest being in the D group (P < 0.05); the mean BC was 495.2, 475.4, and 391.4 ml, with the largest being in the D group (P < 0.05); who commonly had less frequent toileting. The mean post-void residual volume was 106.5, 29.0, and 42.0 ml; the values tended to increase along with BC. In the D group, the mean FS in patients with skin hypoalgesia as detected by pin prick and in those without it was 407.8 and 210.0 ml. The percentage of patients with FS < 100 ml was 5.7%, 0%, and 7.4%, respectively, who commonly had urinary urgency and frequency. CONCLUSIONS: Bladder sensation is affected in diabetic neuropathy more severely than in intermediate/proximal lesions, together with somatic sensory disturbance. Bladder sensory disturbance leads to less frequent toileting, resulting in bladder over-distension and large post-void residuals. A small proportion of patients with peripheral nerve lesions develop urinary urgency, presumably reflecting irritation of the afferent nerve fibers or the urothelium.

Aged↗
PubMed2006

Urinary dysfunction and autonomic control in amyloid neuropathy.

Uro-neurological assessment was performed in four patients with small-fiber neuropathy due to amyloidosis (2 transthyretin-type/2 immunoglobulin light-chain-type). Voiding difficulties were due to detrusor weakness and impaired bladder sensation. In two patients cholinesterase inhibition treatment caused urge incontinence, indicating detrusor denervation supersensitivity. The underlying mechanisms of urinary dysfunction seem to involve postganglionic cholinergic and afferent somatic nerves.

Aged↗
PubMed2006

Videomanometry of the pelvic organs: a comparison of the normal lower urinary and gastrointestinal tracts.

BACKGROUND: Both the lower urinary tract (LUT) and the caudal part of the lower gastrointestinal tract (LGIT) are innervated by the sacral spinal cord. We aimed to compare the normal physiology of the LUT and LGIT using the same videomanometry method. METHODS: We recruited fifteen healthy volunteers (eight men and seven women; mean age, 60 years). The videomanometric measures included fluoroscopic images, subtracted bladder/rectal pressures, urethral/anal sphincter pressures, sphincter electromyography, and urinary/fecal flow. RESULTS: During the resting phase, the urethral/anal sphincter pressures showed almost the same values (mean, 70 cmH2O and 68 cmH2O, respectively). During the storage phase, the volumes at first sensation and maximum capacity for the LGIT (129 mL and 320 mL) were slightly smaller than those for the LUT (170 mL and 405 mL). Compliance of the LGIT (65 mL/cmH2O) was almost as high as that of the LUT (99 mL/cmH2O). However, the LGIT showed spontaneous phasic rectal contractions (SPRC) that were never seen in the bladder. None of the subjects experienced leakage during bladder/rectal filling. During the evacuation phase, rectal contraction on defecation (14 cmH2O) was present, but was weaker than bladder contraction on micturition (42 cmH2O; P < 0.01). Abdominal strain on defecation (70 cmH2O) was greater than that on micturition (25 cmH2O; P < 0.01). Sphincter pressure increase on defecation (13 cmH2O) was greater than that on micturition (-52 cmH2O). An illustrative case of SPRC that were seen during urodynamic recording was shown. CONCLUSION: SPRC and abdominal strain are features of the LGIT, whereas micturition bladder contraction is a feature of the LUT. These features can aid in understanding the possible rectal 'artifacts' of videourodynamics and neurogenic pelvic organ dysfunction.

Adult↗