Which clinical risk factors determine a pathological urodynamic evaluation in patients with multiple sclerosis? an analysis of 100 prospective cases

• Published in: World journal of urology 2013-02, Vol.31 (1), p.229-233
• Main Authors: Wiedemann, A., Kaeder, M., Greulich, W., Lax, H., Priebel, J., Kirschner-Hermanns, R., Füsgen, I.
• Format: Article
• Language: English
• Subjects: Adult; Female; Humans; Incontinence Pads - utilization; Lower Urinary Tract Symptoms - etiology; Lower Urinary Tract Symptoms - physiopathology; Male; Medicine; Medicine & Public Health; Middle Aged; Multiple Sclerosis - complications; Multiple Sclerosis - physiopathology; Multiple Sclerosis, Chronic Progressive - complications; Multiple Sclerosis, Chronic Progressive - physiopathology; Multiple Sclerosis, Relapsing-Remitting - complications; Multiple Sclerosis, Relapsing-Remitting - physiopathology; Nephrology; Oncology; Original Article; Prospective Studies; Risk Factors; Severity of Illness Index; Urinary Bladder, Overactive - etiology; Urinary Bladder, Overactive - physiopathology; Urinary Incontinence - etiology; Urinary Incontinence - physiopathology; Urodynamics - physiology; Urology
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-011-0820-y

Background Urinary tract symptoms are an underestimated problem in multiple sclerosis (MS). Objective Hundred urodynamics of MS patients have been evaluated prospectively. Design, setting and participants In an inpatient rehabilitation, all persons with MS who also suffered from urinary tract symptoms received a voiding diary, post-void sonography and an urodynamic examination according to International Continence-Society-Standard. Results and limitations Between 10/2009 and 3/2011, 100 patients (79 women; 21 men; mean EDSS, 4.52 ± 2.26) were examined who had primary progressive MS (9×), relapsing–remitting MS (41×), secondary progressive MS (43×) and CIS (1×). The mean duration of MS was 10.26 ± 10.09 years and mean duration of LUTS, 6.9 ± 7.75 years. Urodynamic testing showed normal findings in 22 patients, detrusor overactivity in 7, increased bladder sensation without detrusor overactivity in 21, detrusor–sphincter dyssynergia in 26, detrusor hypocontractility in 12, detrusor acontractility in 4 and unclear diagnosis in 8 patients. Statistically significant risk factors for pathological urodynamic findings were as follows: wheelchair dependency, use of more than one incontinence pad per day and a MS type other than relapsing–remitting. Conclusions The urodynamic investigation at hand showed urinary tract dysfunction in 78 of 100 MS patients with lower urinary tract symptoms (LUTS). The long latency between the occurrence of MS and/or the beginning of LUTS and the first neuro-urological evaluation indicates a deficit in treatment. Beyond national guidelines, all MS patients should at regular intervals be questioned about LUTS and receive urodynamic assessment especially according to the presented risk profile.