Urinary Retention in Creutzfeldt-Jakob Disease
Urinary retention can occur as a complication of Creutzfeldt-Jakob disease (CJD), though it is not a typical presenting feature and appears to reflect spinal cord pathology when present. 1, 2
Clinical Evidence for Urinary Retention in CJD
The association between CJD and urinary retention is documented in case reports, though the overall incidence remains unclear:
- Case reports demonstrate that urinary retention can develop in CJD patients, with urodynamic studies revealing detrusor overactivity and neurogenic sphincter electromyogram patterns 2
- The urinary dysfunction in CJD likely reflects pathological lesions in both the prefrontal cortex/basal ganglia and the sacral spinal cord 2
- When urinary retention occurs in CJD, it should be considered a feature of the disease after carefully excluding other etiologies 1
Pathophysiology and Clinical Presentation
The mechanism of urinary dysfunction in CJD is multifactorial:
- Urodynamic findings in CJD patients show diverse patterns including detrusor overactivity during bladder filling and decreased bladder sensation 2
- Neurogenic changes on sphincter EMG suggest involvement of sacral spinal cord pathology 2
- Traditional teaching attributes urinary dysfunction in CJD to functional incontinence from immobility and loss of motivation, but objective urodynamic evidence demonstrates true neurogenic bladder dysfunction 2
Clinical Assessment Recommendations
When evaluating urinary symptoms in suspected or confirmed CJD patients:
- Physicians should evaluate pelvic floor function in CJD patients, particularly by checking post-void residual volumes 1
- Assessment of urinary retention through bladder scanner or in-and-out catheterization is appropriate when urinary symptoms develop 3
- Measurement of urinary frequency, volume, and control should be performed, along with assessment for dysuria 3
Management Approach
If urinary retention develops in a CJD patient:
- Clean intermittent catheterization (CIC) is the standard treatment for urinary retention 4
- Foley catheters should be removed within 48 hours if used, to avoid increased risk of urinary tract infection 3
- Silver alloy-coated urinary catheters should be used if catheterization is required 3
Important Clinical Caveats
- The number of documented cases is small, so urinary retention should not be considered a common or early feature of CJD 1
- Other causes of urinary retention must be carefully excluded before attributing it to CJD itself 1
- Urinary dysfunction may present as either retention or incontinence, and the pattern can vary between patients 1, 2