Behçet's disease (BD) is a chronic inflammatory disorder characterized by recurrent episodes, affecting multiple systems within the body. While its exact cause remains unknown, it notably involves the central nervous system, with a particular impact on the brain and brainstem. Among the various complications associated with Behçet's disease, urinary disorders manifest in a significant portion of patients diagnosed with Neuro-Behçet's Disease (NBD), ranging from 5 to 20%. In light of this, our study sought to conduct a comprehensive clinical assessment and evaluation of vesico-sphincteric dysfunctions specifically within the context of Neuro-Behçet's disease, employing urodynamic techniques for a more thorough understanding of these complications.

This study was conducted prospectively and included 10 patients diagnosed with Neuro-Behçet's disease who presented with urinary symptoms. The research took place at the Department of Physical Medicine and Rehabilitation located in Casablanca. Each patient underwent a comprehensive clinical assessment as well as urodynamic investigations, which encompassed flowmetry, cystomanometry, and profilometry techniques.

The average age of the participants was 31 years, with a notable male predominance. Concerning urinary issues, six patients exhibited clinical symptoms consistent with overactive bladder syndrome, which included increased frequency of urination (pollakiuria), urinary leakage, and urgency. Additionally, four patients reported symptoms of dysuria. Upon urodynamic assessment, findings revealed the following: during flowmetry analysis, seven patients displayed dysuria accompanied by vesico-sphincteric dyssynergy and significant residual urine post-voiding; cystomanometry indicated detrusor hyperactivity with concurrent leakage in eight patients; and profilometry identified sphincteric hypertonia in six patients, while sphincter tone was normal in four patients.

These results corroborate findings observed in three documented cases of neuropathic bladder attributed to Neuro-Behçet's Disease (NBD). In these cases, a spectrum of urinary symptoms was observed, including heightened urinary frequency, episodes of incontinence, detrusor hyperreflexia, and dysfunction in the coordination between the detrusor muscle and the sphincter mechanism, as evidenced by detrusor-sphincter dyssynergy noted during urodynamic evaluations.

Despite the relatively rare occurrence of urinary disorders among patients under active surveillance for Behçet's disease, accounting for only 0.07% of cases, a broader examination reveals a significantly higher prevalence, ranging from 18% to 77%. This wide variation underscores the importance of systematic screening for urinary symptoms in individuals with Behçet's disease.

Among the reported symptoms, irritative signs, particularly urge incontinence, emerge as the most prevalent. These symptoms often arise due to abnormalities in vesico-sphincteric coordination, where the detrusor muscle contracts involuntarily despite the sphincter mechanism being intact, leading to sudden and uncontrollable urges to urinate.

Furthermore, dysuria, characterized by painful or difficult urination, is also commonly reported among individuals with Behçet's disease. This symptom can stem from various underlying causes, including vesico-sphincteric dyssynergy or reduced contractility of the bladder muscle, further highlighting the complex nature of urinary dysfunction in this patient population.

In summary, these detailed observations underscore the necessity of comprehensive evaluation and management of urinary symptoms in individuals with Behçet's disease. By recognizing and addressing these issues early on, healthcare providers can improve the quality of life and overall outcomes for patients living with this challenging condition.

Urinary disorders in Neuro-Behçet's disease should prompt evaluation with a detailed urodynamic assessment to establish an accurate diagnosis of dysfunction.

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