A 45-Year-Old Man Comes to the Emergency Department Due to Urinary

question 375

Multiple Choice

A 45-year-old man comes to the emergency department due to urinary incontinence.  He was diagnosed with multiple sclerosis a year ago after he developed transient acute vision loss in his right eye.  A few weeks ago, he began having difficulty with his balance and had several episodes of urinary incontinence.  The patient's walking has improved since, but he continues to urinate involuntarily.  He has noticed increasing urinary frequency and cannot control the urge to urinate.  His vital signs are normal.  On examination, the patient has mild spastic paraparesis with increased reflexes in the lower extremities; bilateral Babinski sign; and a thoracic sensory level to pain, temperature, and vibration.  An MRI of the spine reveals a new demyelinating lesion in the mid-thoracic spinal cord.  Which of the following abnormalities will most likely be found on this patient's urodynamic studies?

• A)Bladder hypertonia
• B)Delayed bladder emptying
• C)Elevated urethral pressure
• D)Large residual volume of urine
• E)Reduced urine flow

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