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Importance of Urodynamic Dysfunctions as Risk Factors for Recurrent Urinary Tract Infections in Patients with Multiple Sclerosis. URO 2023. [DOI: 10.3390/uro3010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Objective: To analyze the role of urodynamic dysfunctions as risk factors for recurrent urinary tract infections (rUTIs) in patients with multiple sclerosis (MS). Material and methods: We conducted a prospective cohort study of 170 patients with MS who underwent a urodynamic study due to lower urinary tract symptoms. Patients were followed for one year, and 114 (84 women [74%] and 30 men [26%]; mean age 49 years) completed the study. Clinical variables and urodynamic findings (free uroflowmetry, cystometry, and pressure-flow study results) were recorded. Results indicated rUTIs was present in 37 patients (32%). Statistical analysis was performed using Fisher’s exact test, chi-square test, Student’s t-test, and multivariate regression analysis. Results: In univariate analysis, significant differences were observed between patients with and without rUTIs for the following clinical variables: symptom progression time, MS duration, Expanded Disability Status Scale score, and MS type. Regarding urodynamic findings, significant differences were observed in maximum flow rate (Qmax) (lower in patients with rUTIs), voided volume, bladder voiding efficiency, stress urinary incontinence (SUI) (greater rUTI frequency in affected patients), detrusor pressure at maximum flow, and bladder contractility index score. Multivariate analysis identified the urodynamic factors: low Qmax [Odds Ratio (OR) = 0.90 and SUI (OR = 2.95) as the independent predictors of rUTs. Conclusions: Two urodynamic variables: Qmax and SUI, are independent risk factors for rUTIs in MS patients. These two variables might be associated with Pelvic floor dysfunctions.
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Stritt K, Lucca I, Roth B, Grilo N. Is EDSS Enough to Predict Risk of Upper Urinary Tract Damage in Patients with Multiple Sclerosis? Biomedicines 2022; 10:biomedicines10123001. [PMID: 36551757 PMCID: PMC9775948 DOI: 10.3390/biomedicines10123001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Lower urinary tract dysfunction is often observed in patients with multiple sclerosis (MS) and may be responsible for an increased risk of upper urinary tract (UUT) damage. Although there are well-known urodynamic risk factors for UUT damage, no clinical prediction parameters are clearly identified. We aimed to confirm the accuracy of the Expanded Disability Status Scale (EDSS) in predicting urodynamic risk factors for UUT deterioration and to assess other clinical parameters potentially predicting urodynamic risk factors. We retrospectively reviewed 201 patients with MS referred for primary neuro-urological work-up, including a video-urodynamic study (VUDS) from August 2009 to February 2020. Multivariate modeling revealed EDSS, male gender, and a number of LUTS as clinical parameters significantly associated with urodynamic risk factors for UUT damage (p = 0.06, p = 0.01, p = 0.02, respectively). A nomogram combining EDSS, male gender, and a number of different LUTS was created to predict the presence of at least one urodynamic risk factor for UUT damage. In conclusion, the presence of high EDSS combined with male gender and several different LUTS is significantly associated with urodynamic risk factors and can be used to stratify MS patients for further neuro-urological assessment and treatment.
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Beck J, Jaekel AK, Zeller FL, Kowollik M, Kurze I, Kaufmann A, Feneberg W, Brandt A, Flachenecker P, Henze T, Domurath B, Schmidt P, Vance WN, Goldschmidt F, Kirschner-Hermanns RKM, Knüpfer SC. Clinical Predictors of Neurogenic Lower Urinary Tract Dysfunction in Persons with Multiple Sclerosis. Diagnostics (Basel) 2022; 12:diagnostics12010191. [PMID: 35054358 PMCID: PMC8774871 DOI: 10.3390/diagnostics12010191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Multiple sclerosis patients often develop neurogenic lower urinary tract dysfunction with a potential risk of upper urinary tract damage. Diagnostic tools are urodynamics, bladder diary, uroflowmetry, and post-void residual, but recommendations for their use are controversial. Objective: We aimed to identify clinical parameters indicative of neurogenic lower urinary tract dysfunction in multiple sclerosis patients. Methods: 207 patients were prospectively assessed independent of the presence of lower urinary tract symptoms. We analyzed Expanded Disability Status Scale scores, uroflowmetry, post-void residual, rate of urinary tract infections, standardized voiding frequency, and voided volume in correlation with urodynamic findings. Results: We found a significant correlation between post-void residual (odds ratio (OR) 4.17, confidence interval (CI) 1.20–22.46), urinary tract infection rate (OR 3.91, CI 1.13–21.0), voided volume (OR 4.53, CI 1.85–11.99), increased standardized voiding frequency (OR 7.40, CI 2.15–39.66), and urodynamic findings indicative of neurogenic lower urinary tract dysfunction. Expanded Disability Status Scale shows no correlation. Those parameters (except post-void residual) are also associated with reduced bladder compliance, as potential risk for kidney damage. Conclusion: Therefore, bladder diary and urinary tract infection rate should be routinely assessed to identify patients who require urodynamics.
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Affiliation(s)
- Janina Beck
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany; (J.B.); (F.G.); (R.K.M.K.-H.); (S.C.K.)
| | - Anke Kirsten Jaekel
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany; (J.B.); (F.G.); (R.K.M.K.-H.); (S.C.K.)
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany; (F.L.Z.); (M.K.)
- Correspondence: ; Tel.: +49-179-9033123
| | - Federico Leopoldo Zeller
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany; (F.L.Z.); (M.K.)
| | - Michael Kowollik
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany; (F.L.Z.); (M.K.)
| | - Ines Kurze
- Center of Spinal Cord Injuries and Diseases, Department for Paraplegiology and Neuro-Urology, 99438 Bad Berka, Germany;
| | - Albert Kaufmann
- Department of Neuro-Urology, Kliniken Maria Hilf GmbH, 41063 Moenchengladbach, Germany;
| | - Wolfgang Feneberg
- Marianne Strauss Clinic Berg, Therapeutical Center for Patients with Multiple Sclerosis Kempfenhausen GmbH, 82335 Berg, Germany;
| | - Anna Brandt
- Clinic Segeberg, Neurological Center, 23795 Bad Segeberg, Germany;
| | - Peter Flachenecker
- Neurological Rehabilitation Center Quellenhof, 75323 Bad Wildbad, Germany;
| | - Thomas Henze
- Neurological Outpatient Practice Dr. Blersch, 93059 Regensburg, Germany;
| | - Burkhard Domurath
- Neuro-Urological Center, Clinic Beelitz GmbH, Neurological Rehabilitation Clinic, Beelitz-Heilstätten, 14547 Beelitz, Germany; (B.D.); (W.N.V.)
| | - Paul Schmidt
- Statistical Consulting for Science and Research, Große Seestr. 8, 13086 Berlin, Germany;
| | - Will Nelson Vance
- Neuro-Urological Center, Clinic Beelitz GmbH, Neurological Rehabilitation Clinic, Beelitz-Heilstätten, 14547 Beelitz, Germany; (B.D.); (W.N.V.)
| | - Franziska Goldschmidt
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany; (J.B.); (F.G.); (R.K.M.K.-H.); (S.C.K.)
| | - Ruth Klara Maria Kirschner-Hermanns
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany; (J.B.); (F.G.); (R.K.M.K.-H.); (S.C.K.)
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany; (F.L.Z.); (M.K.)
| | - Stephanie C. Knüpfer
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany; (J.B.); (F.G.); (R.K.M.K.-H.); (S.C.K.)
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Seddone S, Marturano M, Bientinesi R, Lucchini M, Bassi P, Mirabella M, Nociti V. Lower urinary tract disorders in multiple sclerosis patients: prevalence, clinical features, and response to treatments. Neurourol Urodyn 2021; 40:1500-1508. [PMID: 34082481 PMCID: PMC8361667 DOI: 10.1002/nau.24687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/07/2021] [Indexed: 11/15/2022]
Abstract
Aims Lower urinary tract symptoms are common in multiple sclerosis (MS) and have a great impact on quality of life. We evaluated prevalence and characteristics of urological symptoms in a cohort of patients with MS. Methods This is a cross‐sectional study conducted on consecutive patients with MS attending our Center in 2018. We evaluated prevalence, clinical features, and response to symptomatic treatments of lower urinary tract disorders; we investigated the relationship between them and clinical and demographic features. Data of urodynamic studies were also collected. Results In our cohort of 806 patients, the overall prevalence of urological symptoms was 52.9% and urgency was the most frequent symptom (59.4%). Symptomatic patients had a higher disability, a longer disease duration, a later age at onset, and a greater mean age at the time of evaluation. Urinary disorders were more frequent in patients with progressive disease and in women. About 41.8% of patients were under treatment for the urological disorder and 81.5% of them reported an improvement of symptoms. Conclusion Urinary disorders in patients with MS have a high prevalence. An early and correct characterization of types of symptoms and an early and targeted therapeutic strategy are essential to improve the patient's quality of life and avoid future complications.
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Affiliation(s)
- Silvia Seddone
- Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Monia Marturano
- Department of Woman and Child Health and Public Health Sciences, Urogynecology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Bientinesi
- Department of Medical and Surgical Sciences, Urological Clinic, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Lucchini
- Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierfrancesco Bassi
- Department of Medical and Surgical Sciences, Urological Clinic, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Mirabella
- Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Viviana Nociti
- Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Moussa M, Abou Chakra M, Papatsoris AG, Dabboucy B, Hsieh M, Dellis A, Fares Y. Perspectives on urological care in multiple sclerosis patients. Intractable Rare Dis Res 2021; 10:62-74. [PMID: 33996350 PMCID: PMC8122310 DOI: 10.5582/irdr.2021.01029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. Lower urinary tract dysfunction due to MS includes a dysfunction of the storage phase or dysfunction of the voiding phase or a detrusor-sphincter dyssynergia. Baseline evaluation includes a voiding chart, an ultrasound scan of the urinary tract, urine culture, and an urodynamic study. For storage symptoms, antimuscarinics are the first-line treatment, and clean intermittent catheterization (CIC) is indicated if there is concomitant incomplete bladder emptying. Intradetrusor injections with botulinum toxin A (BTX-A), are recommended for refractory cases. Urinary diversion is rarely indicated. For patients with voiding symptoms, CIC and alpha-blockers are usually offered. Sexual dysfunction in patients with MS is multifactorial. Phosphodiesterase type 5 inhibitors are first-line therapies for MS-associated erectile dysfunction in both male and female patients. This review summarizes the epidemiology, pathogenesis, risk factors, genetic, clinical manifestations, diagnostic tests, and management of MS. Lastly, the urologic outcomes and therapies are reviewed.
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Affiliation(s)
- Mohamad Moussa
- Chairman of Urology Department, Lebanese University & Al Zahraa Hospital, University Medical Center, Beirut, Lebanon
| | - Mohamad Abou Chakra
- Urology Department, Lebanese University, Beirut, Lebanon
- Address correspondence to:Mohamad Abou Chakra, Faculty of Medicine, Department of Urology, Lebanese University. Beirut, Lebanon. E-mail:
| | - Athanasios G. Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Baraa Dabboucy
- Department of Neurosurgery, Lebanese University, Beirut, Lebanon
| | - Michael Hsieh
- Division of Urology, Children's National Hospital, Washington, USA
- Department of Urology, The George Washington University, Washington, USA
| | - Athanasios Dellis
- Department of Urology/General Surgery, Areteion Hospital, Athens, Greece
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Domurath B, Flachenecker P, Henze T, Feneberg W, Brandt A, Kurze I, Kirschner-Hermanns R, Kaufmann A, Bremer J, Vonthien M, Ratering K, Schäfer C, Vance WN, Schmidt P. [Current aspects of neurogenic dysfunctions of the lower urinary tract in multiple sclerosis]. DER NERVENARZT 2021; 92:349-358. [PMID: 33399923 PMCID: PMC8026406 DOI: 10.1007/s00115-020-01046-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND In the clinical management of patients with multiple sclerosis (MS), the challenge is to make an early diagnosis and initiate adequate treatment of neurogenic disorders of the lower urinary tract (NLUTD). Various national guidelines provide practical recommendations which are sometimes discordant. OBJECTIVE To develop a simple evidence-based algorithm for detecting NLUTD in patients with MS that could be taken as a principle for deriving therapeutic consequences. MATERIAL AND METHODS A prospective multicenter study was initiated as a direct result of two multidisciplinary conferences. The aim was to identify statistically and clinically relevant parameters for the routine diagnosis of NLUTD in patients with MS. Urodynamic abnormalities served as the gold standard. At three subsequent consensus conferences, the results of the study were discussed, a diagnostic algorithm was developed and consensus was reached on a first-line treatment. RESULTS AND DISCUSSION The proposed algorithm enables the detection of NLUTD in patients with MS with the help of four statistically significant predictors: 1) the residual urine volume, 2) the number of urinary tract infections (UTI) within the last 6 months, 3) the standardized micturition frequency and 4) the presence/absence of urinary incontinence. The newly developed algorithm has proved to be efficient with the following results: approximately 75% of the patients do not need a urodynamic examination for a first-line treatment decision. In 25% of cases, urodynamic examinations are essential for an adequate treatment decision. Routine assessments include the patient medical history, residual urine volume measurement, a micturition diary and a uroflowmetry (optional).
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Affiliation(s)
- Burkhard Domurath
- Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6A, 14547, Beelitz Heilstätten, Deutschland.
| | - Peter Flachenecker
- Neurologisches Rehabilitationszentrum Quellenhof, Bad Wildbad, Deutschland
| | - Thomas Henze
- Praxis für Neurologie Dr. Blersch, Regensburg, Deutschland
| | - Wolfgang Feneberg
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gemeinnützige GmbH, Berg, Deutschland
| | - Anna Brandt
- Neurologisches Zentrum, Segeberger Kliniken, Bad Segeberg, Deutschland
| | - Ines Kurze
- Querschnittgelähmten-Zentrum, Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka GmbH, Bad Berka, Deutschland
| | - Ruth Kirschner-Hermanns
- Sektion Neurourologie, Klinik für Urologie und Kinderurologie, Universitätsklinikum Bonn und Neuro-Urologie, Neurologisches Rehabilitationszentrum der "Godeshöhe" e. V., Bonn, Deutschland
| | - Albert Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH, Mönchengladbach, Deutschland
| | - Jörn Bremer
- Querschnittgelähmtenzentrum, BDH Klinik Greifswald gGmbH, Greifswald, Deutschland
| | | | | | - Christoph Schäfer
- Rehaklinik für Neurologie und Orthopädie, Johanniter-Klinik am Romberg, Dortmund, Deutschland
| | - Will Nelson Vance
- Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6A, 14547, Beelitz Heilstätten, Deutschland
| | - Paul Schmidt
- Statistik, Große Seestraße, 813086, Berlin, Deutschland
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Domurath B, Kurze I, Kirschner-Hermanns R, Kaufmann A, Feneberg W, Schmidt P, Henze T, Flachenecker P, Brandt A, Vance WN, Beck J, Vonthien M, Ratering K. Neurourological assessment in people with multiple sclerosis (MS): a new evaluated algorithm. Mult Scler Relat Disord 2020; 44:102248. [DOI: 10.1016/j.msard.2020.102248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/17/2020] [Accepted: 05/27/2020] [Indexed: 01/20/2023]
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Lower urinary tract dysfunction in patients with multiple sclerosis: A post-void residual analysis of 501 cases. Mult Scler Relat Disord 2020; 45:102378. [PMID: 32683303 DOI: 10.1016/j.msard.2020.102378] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/22/2020] [Accepted: 07/04/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) are common in individuals with multiple sclerosis (MS), and can have a significant impact on quality of life (QoL). Prevalence of LUTS in MS ranges from 32% to 96.8%, including storage or voiding symptoms or a combination of these. Post-void residual (PVR) is a very well-tolerated, non-invasive test for evaluating voiding dysfunction. The aim of the current study was to describe the distribution of PVR volumes across MS subjects with and without LUTS and to examine relationships between storage symptoms, voiding symptoms, and PVR. METHODS A large group of subjects (N = 501) completed a questionnaire on LUTS (current bladder management, number of urinary tract infections in the last year and urological investigations). A bladder ultrasound for PVR was performed and data were collected. We used Chi-Square and the Mann-Whitney non-parametric tests respectively for categorical and continuous variables in order to assess differences between symptomatic and asymptomatic groups. The differences of PVR by LUTS status were explored using the Mann-Whitney non-parametric test for independent samples. RESULTS Overall mean PVR was 132.4 mL (PVR>100 ml was considered an abnormal residual urine volume). Based on the LUTS questionnaire, 43 subjects (8.6%) were asymptomatic, while 458 subjects (91.4%) reported at least one LUTS. Storage-related symptoms were reported by 87.2% of subjects (437) and 65.1% (326) reported at least one voiding-related symptom. Two-third of subjects (66.5%) reported three or more LUTS. There was a statistically significant association between the presence of LUTS and the number of infections reported (p = 0.0015). The symptomatic group had significantly higher PVR than the asymptomatic group (p = 0.011). PVR significantly correlated with male gender, disability level and a progressive disease course. CONCLUSION Results showed a high prevalence of LUTS in subjects with MS and that storage symptoms are predominant. There was an association between the presence of LUTS and a progressive disease course. The relationship between LUTS, higher PVR and the severity of disease course indicates that a comprehensive clinical evaluation should include an assessment of both neurological and micturition disorders and, importantly, PVR should be measured at every clinical assessment, despite the presence or absence of LUTS.
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Bladder and urodynamic changes in multiple sclerosis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
Urinary dysfunction is a common symptom during the course of multiple sclerosis (MS). Long-term follow-up of the natural history of bladder dysfunction in MS has been seldom addressed.
Objective
To identify the type and the course of voiding dysfunction in MS patients in relation to the urodynamic changes of the lower urinary tract (LUT)
Subjects and methods
An observational prospective study including 120 MS patients with urinary dysfunction rated by the American Urological Association (AUA) symptoms questionnaire and assessed by urodynamic studies and followed for 1 year.
Results
Irritative symptoms were the most frequently encountered symptoms (90%), whereas overactive bladder was recorded by urodynamic studies in 35% of subjects. Urinary symptoms severity score was higher in patients with initial urodynamic abnormalities by the end of the 1-year follow-up period (P < 0.001). A statistically significant relationship was found between urinary symptoms severity score and each of expanded disability status scale (EDSS) and urodynamic pattern of abnormalities (P < 0.01).
Conclusion
Irritative symptoms and overactive bladder seem to be the most frequent urinary dysfunction in MS patients. Urinary symptoms are related to the degree of disability. The initial urodynamic abnormalities are associated with worse urinary dysfunction outcome after 1 year.
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Abello A, Badin J, Das AK. Worsening disability status in multiple sclerosis predicts urologic complications. Int Urol Nephrol 2020; 52:859-863. [PMID: 31983045 DOI: 10.1007/s11255-020-02381-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Multiple sclerosis (MS) causes voiding dysfunction and might predispose to urologic complications. However, long-term complications and risk factors for complications are unknown. We aim to assess long-term changes in voiding function and to determine risk factors for urologic complications during MS follow-up. METHODS We analyzed the records of MS patients and recorded baseline and follow-up voiding symptoms, urodynamic (UDS) findings, Expanded Disability Status Scale (EDSS), serum blood studies, imaging, and complications. T test and Chi-square test were used to determine statistical significance using a two-tailed p value < 0.05. We assessed complication-free survival using Kaplan-Meier curves and performed multiple variable Cox proportional hazard models to estimate hazard ratios predicting complications for various independent variables. RESULTS 126 women and 35 men with MS were followed for a median of 9.7 years (IQR 4.3-13). Mean age at MS diagnosis was 36.7 with a mean EDSS of 3.2. During follow-up, EDSS progressed to a mean of 5.5. In addition, at least one complication occurred in 60.2% and major complications were present in 16.7%. After multivariable analysis, EDSS progression ≥ 2.0 (p = 0.003), follow-up EDSS ≥ 6.0 (p = 0.01), use of intermittent catheterization (p < 0.001) and urinary reconstruction with continent catheterizable stoma (p = 0.009) were significantly related to an increased hazard for any complications. CONCLUSION Upper tract changes and other major complications were uncommon. Complications were related to MS progression, resultant increase in total disability, and the need for intervention to maintain functional continence. Lower tract infections occurred more frequently in patients with the need for catheterization.
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Affiliation(s)
- Alejandro Abello
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Badin
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Rabb 440, Urology, Boston, MA, 02215, USA.
| | - Anurag K Das
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Rabb 440, Urology, Boston, MA, 02215, USA
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Averbeck MA, Iacovelli V, Panicker J, Schurch B, Finazzi Agrò E. Urodynamics in patients with multiple sclerosis: A consensus statement from a urodynamic experts working group. Neurourol Urodyn 2019; 39:73-82. [PMID: 31746485 DOI: 10.1002/nau.24230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/12/2022]
Abstract
AIMS Urodynamics (UDS) is often indicated for multiple sclerosis (MS) patients either at presentation to specialized medical centers or after failure of conservative management of lower urinary tract dysfunction (LUTD). However, the ideal moment and context to indicate this exam in this group of patients remain controversial. We aimed to establish a consensus panel to address the role of UDS in MS patients. METHODS A panel representing urology, rehabilitation medicine, and neurology skilled in neuro-urology participated in a consensus-forming project using a Delphi method to reach consensus on the role of UDS in MS patients. RESULTS In total, five experts participated. All panelists participated in the four phases of the consensus process. Consensus was reached if ≥70% of the experts agreed on recommendations. To facilitate a common understanding among all experts, a face-to-face consensus meeting was held in Florence in September 2017 and then with a follow-up teleconference in March 2018. By the end of the Delphi process, formal consensus was achieved for 100% of the items and an algorithm was then developed in a face-to-face meeting in Philadelphia in August 2018. The final expert opinion recommendations were approved by the unanimous consensus of the panel. CONCLUSIONS UDS represents an important diagnostic tool for MS patients and is particularly useful to evaluate the pattern of LUT dysfunction in high-risk patients. There is a lack of high-evidence level studies to support an optimal urodynamic long-term follow-up protocol.
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Affiliation(s)
- M A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - V Iacovelli
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy.,Urology Unit, San Carlo di Nancy General Hospital - GVM Care and Research, Rome, Italy
| | - J Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
| | - B Schurch
- Neurourology Unit, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
| | - E Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
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Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Executive summary. Can Urol Assoc J 2019; 13:156-165. [PMID: 31199234 DOI: 10.5489/cuaj.6041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
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13
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Tomé ALF, Miranda EP, de Bessa Júnior J, Bezerra CA, Pompeo ACL, Glina S, Gomes CM. Lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis. Clinics (Sao Paulo) 2019; 74:e713. [PMID: 30892415 PMCID: PMC6399658 DOI: 10.6061/clinics/2019/e713] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 12/05/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the prevalence and interrelationship between lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis (MS). METHODS In a cross-sectional study, we evaluated 41 men (mean age 41.1±9.9 years) with MS from February 2011 to March 2013, who were invited to participate irrespective of the presence of lower urinary tract symptoms or sexual dysfunction. Neurological impairment was assessed with the Expanded Disability Status Scale; lower urinary tract symptoms were evaluated with the International Continence Society male short-form questionnaire, and sexual dysfunction was evaluated with the International Index of Erectile Function. All patients underwent transabdominal urinary tract sonography and urine culture. RESULTS The mean disease duration was 10.5±7.3 years. Neurological evaluation showed a median Expanded Disability Status Scale score of 3 [2-6]. The median International Continence Society male short-form questionnaire score was 17 [10-25]. The median International Index of Erectile Function score was 29 [15-46]. Twenty-nine patients (74.4%) had sexual dysfunction as defined by an International Index of Erectile Function score <45. Voiding dysfunction and sexual dysfunction increased with the degree of neurological impairment (r=0.02 [0.02 to 0.36] p=0.03 and r=-0.41 [-0.65 to -0.11] p=0.008, respectively). Lower urinary tract symptoms and sexual dysfunction also displayed a significant correlation (r=-0.31 [-0.56 to -0.01] p=0.04). CONCLUSIONS Most male patients with MS have lower urinary tract symptoms and sexual dysfunction. The severity of the neurological disease is a predictive factor for the occurrence of voiding and sexual dysfunctions.
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Affiliation(s)
- André Luiz Farinhas Tomé
- Divisao de Urologia, Faculdade de Medicina do ABC, Santo Andre, SP, BR
- Divisao de Urologia, Associacao Brazileira de Esclerose Multipla (ABEM), Sao Paulo, SP, BR
| | - Eduardo P Miranda
- Divisao de Urologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - José de Bessa Júnior
- Divisao de Urologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | - Sidney Glina
- Divisao de Urologia, Faculdade de Medicina do ABC, Santo Andre, SP, BR
| | - Cristiano Mendes Gomes
- Divisao de Urologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text. Can Urol Assoc J 2019; 13:E157-E176. [PMID: 30763235 DOI: 10.5489/cuaj.5912] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
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15
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Lower Urinary Tract Symptoms in Elderly Population With Multiple Sclerosis. Int Neurourol J 2018; 22:58-64. [PMID: 29609425 PMCID: PMC5885135 DOI: 10.5213/inj.1835054.527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/22/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose The aim of this study is to compare the clinical and urodynamic characteristics of urinary disorders in multiple sclerosis (MS) patients in a geriatric population with a nongeriatric population. Methods This study was conducted retrospectively between 2010 and 2016. Each patient with MS aged 65 and older was matched with 2 patients with MS aged less than 65 in sex, form of MS, and Expended Disability Status Scale (EDSS). Demographic data, urinary symptoms, treatment, quality of life, repercussion of lower urinary tract symptoms on daily life activities and psychological state and urodynamic parameters were collected. Differences between the 2 populations were evaluated using Student test, chi-square, or Fischer tests. Results Twenty-four patients with MS aged 65 and older (mean age, 69.8 years) were matched with 48 patients aged less than 65 years (mean age, 49.4 years). Maximum urethral closure pressure was lower in the elderly population than in the nongeriatric population (mean±standard deviation [SD]: 35.6±18.5 cm H<sub>2</sub>O vs. 78.2±52.3 cm H<sub>2</sub>O, P<0.001). In the male population, there was no statistical difference in any other clinical or urodynamic endpoints. In the female population, voiding symptoms was more described in the nongeriatric population (Urinary Symptom Profile low stream: 3.4±3.5 vs. 1.7±2.4, P=0.04), geriatric population had less urinary treatment (P=0.05). LUTS had less impact on quality of life (Qualiveen: 1.4±1.0 vs. 2.1±0.9, P=0.02) on the geriatric population than in the nongeriatric of female MS patients. Conclusions Geriatric population of MS has few differences of urinary disorders compared to a nongeriatric population with EDSS, sex, and MS form equal. However, the psychological impact of these urinary disorders is less important in female geriatric population.
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Abstract
It is widely accepted that neurogenic lower urinary tract dysfunction, when left untreated, has a natural history that has a potential for causing deterioration of renal function over time. However, certain patient profiles are at risk for this and other complications. This can be linked to their underlying neurologic disease process. Identifying risk profiles allows the provider to determine what surveillance strategies might be adopted. Risk factors for upper urinary tract deterioration include loss of bladder compliance, repeated bouts of pyelonephritis, and chronic indwelling catheterization. Other long-term complications include nephrolithiasis, refractory urinary incontinence, and malignancy.
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Affiliation(s)
- Unwanaobong Nseyo
- Department of Urology, UC San Diego Health, University of California-San Diego, 200 West Arbor Drive, San Diego, CA 92103-8897, USA
| | - Yahir Santiago-Lastra
- Department of Urology, UC San Diego Health, University of California-San Diego, 200 West Arbor Drive, San Diego, CA 92103-8897, USA.
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17
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18
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Ineichen BV, Schneider MP, Hlavica M, Hagenbuch N, Linnebank M, Kessler TM. High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis. Mult Scler 2017; 24:529-534. [PMID: 28367674 DOI: 10.1177/1352458517703801] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurogenic lower urinary tract dysfunction (NLUTD) is very common in patients with multiple sclerosis (MS), and it might jeopardize renal function and thereby increase mortality. Although there are well-known urodynamic risk factors for upper urinary tract damage, no clinical prediction parameters are available. OBJECTIVE We aimed to assess clinical parameters potentially predicting urodynamic risk factors for upper urinary tract damage. METHODS A consecutive series of 141 patients with MS referred from neurologists for primary neuro-urological work-up including urodynamics were prospectively evaluated. Clinical parameters taken into account were age, sex, duration, and clinical course of MS and Expanded Disability Status Scale (EDSS). RESULTS Multivariate modeling revealed EDSS as a clinical parameter significantly associated with urodynamic risk factors for upper urinary tract damage (odds ratio = 1.34, 95% confidence interval (CI) = 1.06-1.71, p = 0.02). Using receiver operator characteristic (ROC) curves, an EDSS of 5.0 as cutoff showed a sensitivity of 86%-87% and a specificity of 52% for at least one urodynamic risk factor for upper urinary tract damage. CONCLUSION High EDSS is significantly associated with urodynamic risk factors for upper urinary tract damage and allows a risk-dependent stratification in daily neurological clinical practice to identify MS patients requiring further neuro-urological assessment and treatment.
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Affiliation(s)
- Benjamin V Ineichen
- Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland/Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Marc P Schneider
- Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland/Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Martin Hlavica
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Michael Linnebank
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland/Department of Neurology, HELIOS-Klinik Hagen-Ambrock, Hagen, Germany
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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19
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Aharony SM, Lam O, Corcos J. Evaluation of lower urinary tract symptoms in multiple sclerosis patients: Review of the literature and current guidelines. Can Urol Assoc J 2017; 11:61-64. [PMID: 28443147 DOI: 10.5489/cuaj.4058] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Multiple sclerosis (MS) is a unique neurological disease with a broad spectrum of clinical presentations that are time- and disease course-related. MS plaque location (intracranial and/or spinal) is a key feature in the pathophysiology of disease-related lower urinary tract symptoms (LUTS). The prevalence of these symptoms in MS patients is very high, with nearly 90% of them experiencing some degree of voiding dysfunction and/or incontinence. LUTS rarely present as primary MS manifestations and usually appear 6-8 years after the initial diagnosis. Symptom severity usually correlates with the disability status of patients. Patient assessment comprises clinical and advanced investigations. Each patient should be evaluated uniquely, after taking into account his/her symptoms, disease course and length, comorbidities, physical status, and medications. Basic investigation includes detailed history-taking, physical examination, and post-void residual volume measurement. Advanced evaluation consists of imaging and specific testing, with pivotal importance on urodynamic study.
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Affiliation(s)
| | - Ornella Lam
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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20
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Wang T, Huang W, Zhang Y. Clinical Characteristics and Urodynamic Analysis of Urinary Dysfunction in Multiple Sclerosis. Chin Med J (Engl) 2017; 129:645-50. [PMID: 26960366 PMCID: PMC4804409 DOI: 10.4103/0366-6999.177970] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Both lower urinary tract dysfunction and urinary symptoms are prevalent in patients with multiple sclerosis (MS). Although the significance of identifying and treating urinary symptoms in MS is currently well-known, there is no information about the real prevalence and therapeutic effect of urinary symptoms in patients with MS. The purpose of this study was to analyze the major symptoms and urodynamic abnormalities, and observe the therapeutic effect in different MS characteristics. Methods: We enrolled 126 patients with urological dysfunction who were recruited between July 2008 and January 2015 in Beijing Tian Tan Hospital, Capital Medical University and conducted overactive bladder system score (OABSS), urodynamic investigation, and expanded disability status scale (EDSS). Changes of urinary symptoms and urodynamic parameters were investigated. Results: Urgency was the predominant urinary symptom, and detrusor overactivity was the major bladder dysfunction. There was a positive correlation between EDSS and OABSS. Clinically isolated syndrome (CIS) had lowest EDSS and OABSS. CIS exhibited significant improvements in OABSS, maximum urinary flow rate (Qmax), and bladder volume at the first desire to voiding and maximum bladder volume after the treatment (P < 0.05). Relapsing–remitting MS showed significant improvements in the OABSS, Qmax, and bladder volume at the first desire to voiding, maximum bladder volume and bladder compliance after the treatment (P < 0.05). Progressive MS exhibited significant increase in the bladder volume at the first desire to voiding, the detrusor pressure at maximum flow rate (PdetQmax), and bladder compliance after the treatment (P < 0.05). Conclusions: Urodynamic parameters examined are important in providing an accurate diagnosis, guiding management decisions of MS. Early and effective treatment may improve the bladder function and the quality of life at the early stages of MS.
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Affiliation(s)
| | | | - Yong Zhang
- Department of Urology, Neurourology Research Division, Beijing Tian Tan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Disease, Beijing 100050, China
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21
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Sadiq A, Brucker BM. Management of neurogenic lower urinary tract dysfunction in multiple sclerosis patients. Curr Urol Rep 2016; 16:44. [PMID: 26025495 DOI: 10.1007/s11934-015-0519-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple sclerosis (MS) can be a debilitating neurological condition that attributes significant morbidity to bladder dysfunction. Although many effective treatment options exist, symptomatic patients are often underdiagnosed and undertreated. The purpose of this article is to give an overview of the current literature including new screening tools to identify symptomatic patients and updates on treatment options including medications, botulinum toxin, and neuromodulation.
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Affiliation(s)
- Areeba Sadiq
- Department of Urology, New York University Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY, 10016, USA,
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22
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Averbeck MA, Madersbacher H. Follow-up of the neuro-urological patient: a systematic review. BJU Int 2015; 115 Suppl 6:39-46. [PMID: 25891319 DOI: 10.1111/bju.13084] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To systematically review the long-term urological follow-up strategies for patients with neurogenic lower urinary tract dysfunction (NLUTD), focusing on three main groups of neurological diseases: (i) spinal cord injuries, (ii) spinal dysraphism, and (iii) multiple sclerosis. PATIENTS AND METHODS Data acquisition comprised electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE) database and the EMBASE database in August 2014 to retrieve English language studies. MEDLINE and EMBASE search included the following medical subject heading (MeSH) terms: (i) neurogenic bladder and (ii) neurogenic bladder dysfunction. Each of these terms was crossed with (i) long-term care and (ii) long-term surveillance. Only studies related to NLUTD and urological follow-up were included. Studies were also identified by hand search of reference lists and review articles. RESULTS Initial records identified through database searching included 265 articles. In all, 23 articles were included in the quantitative synthesis. The proposed time schedule of investigations as well as the amount and type of investigation were different according to specific neurological lesions. They depend on the dysfunctional pattern of the lower urinary tract (LUT) and its risk profile. However, there is a lack of high-evidence level studies to support an optimal long-term follow-up protocol. CONCLUSIONS The goal of neuro-urological management is the best possible preservation of upper urinary tract (UUT) and LUT function in relation to the individual neurological disorder. Regular and risk adapted controls ('urochecks') allow detection of risk-factors in time before irreversible changes of the LUT and UUT have occurred. With risk- and patient-oriented lifelong regular urological care an optimised quality of life and life-expectancy can be achieved, although there is a complete lack of high-evidence level studies on this topic.
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23
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Dillon BE, Lemack GE. Urodynamics in the Evaluation of the Patient with Multiple Sclerosis. Urol Clin North Am 2014; 41:439-44, ix. [DOI: 10.1016/j.ucl.2014.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Amarenco G, de Sèze M, Ruffion A, Sheikh Ismael S. Clinical and urodynamic evaluations of urinary disorders in multiple sclerosis. Ann Phys Rehabil Med 2014; 57:277-287. [PMID: 24980885 DOI: 10.1016/j.rehab.2014.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022]
Abstract
Urinary dysfunction is a major clinical problem and a significant cause of disability in multiple sclerosis (MS) patients. Indeed, the bothersome symptom of urinary dysfunction may adversely affect social relationships and activities in MS patients. Since many causes of urinary dysfunction are described, a thorough evaluation including history, clinical examination and evaluation of quality of life is necessary. Generally, diagnosis of urinary disorders is complex with intricated pathophysiologic factors. In these cases, urodynamic investigations are necessary to better understand symptoms pathophysiology and choose the best treatment.
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Affiliation(s)
- G Amarenco
- Sorbonne universités, UPMC université Paris-6, GRC n(o) 01 GREEN (Group of Clinical Research in Neuro-Urology), 4, place Jussieu, 75252 Paris cedex 05, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - M de Sèze
- Clinique Saint-Augustin, 114, avenue d'Ares, 33000 Bordeaux, France
| | - A Ruffion
- Service d'urologie, CNRS, Inra, institut de génomique fonctionnelle de Lyon, centre hospitalier Lyon Sud, hospices civils de Lyon, université de Lyon, 69229 Lyon cedex 02, France
| | - S Sheikh Ismael
- Sorbonne universités, UPMC université Paris-6, GRC n(o) 01 GREEN (Group of Clinical Research in Neuro-Urology), 4, place Jussieu, 75252 Paris cedex 05, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
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25
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Lower Urinary Tract Dysfunction in Multiple Sclerosis. CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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