Evaluation and therapeutic approaches of voiding and erectile dysfunction in neurological Behcet's syndrome

Purpose: Behcet's syndrome is a progressive inflammatory disease which invo lves multiple systems. It is characterized by 3 main symptoms of iridocycli tis, and oral and genital ulcerations, Nervous system involvement is seen r arely in this clinical entity and is known as neurological Behcet's syndrom e. Inflammation usually occurs in the brain stem, cerebellum and medulla sp inalis. Voiding and erectile dysfunction can be due to progressive inflamma tory reactions in the nervous and vascular systems. We prospectively evalua ted the dysfunctional bladder and penis, and therapeutic options were evalu ated prospectively. Materials and Methods: A total of 24 consecutive patients diagnosed with ne urological Behcet's syndrome after neurological evaluation were enrolled in this study. Neurological involvement and localization of the nervous syste m were proved on evaluation. Voiding and erectile dysfunction was evaluated regardless of the presence of related symptoms, and the results were compa red with those of controls. Patients with voiding dysfunction on urodynamic study were treated and reevaluated symptomatically after 3 and urodynamica lly after 6 months. Results: The rate of erectile dysfunction in neurological Behcet's syndrome was 63%. Mixed type vasculogenic impotence, arterial insufficiency, veno-o cclusive dysfunction and neurogenic impotence were identified in 7, 2, 2 an d 1 patient, respectively. Detrusor instability was demonstrated in 12 pati ents with urgency incontinence, including 3 with detrusor-sphincter dyssyne rgia. Brain stem localization was determined in these patients on neurogeni c evaluation. Significant improvement was observed with anticholinergic tre atment and clean intermittent catheterization in 3 patients with detrusor-s phincter dyssynergia. Hypersensitive and hypocompliant detrusor was noted i n patients with neurological Behcet's syndrome who had normal voiding habit s. Conclusions: Incontinence or irritable bladder symptoms should not be consi dered innocuous clinical findings in neurological Behcet's syndrome. Lower urinary tract function should be evaluated in all patients with this neurol ogical syndrome. The incidence of erectile dysfunction is approximately 65% and the therapeutic approach should be. determined according to lower urin ary tract function.