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Kurze I, Jaekel AK. [Neuro-urological diagnostics and treatment of non-traumatic/degenerative neurogenic lower urinary tract dysfunction exemplified by multiple sclerosis]. Aktuelle Urol 2024; 55:315-325. [PMID: 38653466 DOI: 10.1055/a-2281-7924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Neurogenic lower urinary tract dysfunction in multiple sclerosis is often underestimated, underdiagnosed, and inadequately treated. Depending on the course of the disease and the location of neural damage, it occurs with varying frequency and types of impairment of urine storage and voiding function. Symptoms such as urinary incontinence, recurrent urinary tract infections, urgency, pollakiuria, reduced urinary flow, hesitancy as well as postvoid residual urine may occur. However, the symptoms do not allow any conclusions to be drawn about the underlying type of neurogenic lower urinary tract dysfunction. Although numerous data, publications, and guidelines are available on this topic today, there continues to be a lack of standardized screening parameters and algorithms that have been tested in prospective studies for multiple sclerosis. This article presents the current diagnostic and therapeutic options of neurogenic lower urinary tract dysfunction in multiple sclerosis. A crucial issue is the initial delay in diagnosis, not least due to a lack of communication between neurologists and urologists. Initial indicators of the presence of neurogenic lower urinary tract dysfunction can be obtained by actively asking about the subjective presence of symptoms such as urinary incontinence or the occurrence of urinary tract infections. However, a subjective lack of symptoms does not rule out a neurogenic lower urinary tract dysfunction. Regardless of the stage of the disease, an early and individualized neuro-urological diagnosis and treatment should be implemented. All aspects of the damage and the extent of functional deficits in other organ systems caused by multiple sclerosis must be included in this neuro-urological treatment decision, which requires a consistent interdisciplinary exchange between neurologists, general practitioners, and urologists. This interdisciplinary and interprofessional way of thinking and acting is key for an optimal treatment using the numerous therapeutic procedures. Lifelong, individual, risk-adapted urological care for the early detection and prevention of neuro-urological complications should be offered to persons with multiple sclerosis.
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Affiliation(s)
- Ines Kurze
- Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka Gmbh, Bad Berka, Germany
| | - Anke K Jaekel
- Klinik für Urologie und Kinderurologie, Sektion Neuro-Urologie, Universitätsklinikum Bonn, Bonn, Germany
- Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshoehe GmbH, Bonn, Germany
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2
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Campetella M, Filomena GB, Marino F, Fantasia F, Russo P, Gavi F, Rossi F, Gandi C, Ragonese M, Foschi N, Totaro A, Sacco E, Racioppi M, Bientinesi R. Etiology, presentation and management of urinary tract infections in multiple sclerosis patients: A review of the current literature. Urologia 2024; 91:384-393. [PMID: 38279809 DOI: 10.1177/03915603231224511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Urinary tract infections (UTIs) present a formidable challenge in the care of individuals affected by multiple sclerosis (MS). Lower urinary tract dysfunction is a prevalent issue among MS patients, predisposing them to an elevated risk of UTIs. When left untreated, UTIs can further exacerbate the already compromised quality of life in individuals with MS. The diagnosis and management of UTIs in MS patients necessitate a careful clinical evaluation. The objective of this review is to delineate preventive strategies and current and developing therapeutic approaches for preventing and treating UTIs associated with urinary dysfunction, catheterization, and upper urinary tract infections in patients with MS. Effectively addressing UTIs and urinary tract dysfunction in individuals with multiple sclerosis calls for a comprehensive, interdisciplinary approach.
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Affiliation(s)
- Marco Campetella
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - G B Filomena
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Marino
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Fantasia
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Russo
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Gavi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Rossi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Gandi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Ragonese
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - N Foschi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Totaro
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Racioppi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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Koutsouraki E, Theodoros K, Eleni G, Marianna K, Areti N, Ariadni K, Dimitrios M. Autonomic nervous system disorders in multiple sclerosis. J Neurol 2023:10.1007/s00415-023-11725-y. [PMID: 37084150 DOI: 10.1007/s00415-023-11725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
Multiple sclerosis (MS) is a chronic progressive demyelinating disease of the central nervous system (CNS), which also affects the autonomic nervous system (ANS). Manifestations of MS in the ANS include urological, sexual, gastrointestinal, cardiovascular, and thermoregulatory disorders as well as increased fatigue. These problems are common yet are often underestimated due to the non-specificity of the symptoms and the limited evaluation of the ANS in the usual clinical practice. Most of these symptoms seem to be related to localized lesions in the CNS. However, the mechanisms by which these disorders are caused in MS have not been fully investigated, thus preventing any focused etiological treatment. The most common disorders of the ANS in MS represent a challenge for clinicians due to the variability of the clinical picture and our minimal data on their diagnosis and treatment. Early diagnosis and initiation of individualized treatment regimens, often in need of multiple approaches, seem to yield the best results in managing ANS dysfunction in MS patients.
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Affiliation(s)
- Effrosyni Koutsouraki
- First Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | | | | | | | - Koukoulidou Ariadni
- Nursing School, International University of Greece, Sindos, Thessaloniki, Greece
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Crnošija L, Adamec I, Krbot Skorić M, Habek M. How to explore and explain autonomic changes in multiple sclerosis. Neurophysiol Clin 2023; 53:102854. [PMID: 36966707 DOI: 10.1016/j.neucli.2023.102854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Autonomic dysfunction (AD) in people with MS (pwMS) is a frequent finding. This narrative review will present an overview of central neural mechanisms involved in the control of cardiovascular and thermoregulatory systems, and methods of autonomic nervous system testing will be discussed thereafter. Since the need for standardization of autonomic nervous system (ANS) testing, we will focus on the standard battery of tests (blood pressure and heart rate response to Valsalva maneuver and head-up tilt, and heart rate response to deep breathing test plus one of the tests for sudomotor function), which can detect ANS pathology in the majority of pwMS. The review will briefly discuss the other types of AD in pwMS and the use of appropriate tests. While performing ANS testing in pwMS one has to consider the multiple sclerosis phenotypes, disease duration, and its activity, the degree of clinical disability of patients included in the study, and the disease-modifying therapies taken, as these factors may have a great influence on the results of ANS testing. In other words, detailed patient characteristics presentation and patient stratification are beneficial when reporting results of ANS testing in pwMS.
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Jaekel AK, Winterhagen FI, Zeller FL, Butscher AL, Knappe FK, Schmitz F, Hauk C, Stein J, Kirschner-Hermanns RKM, Knüpfer SC. Neurogenic Lower Urinary Tract Dysfunction in Asymptomatic Patients with Multiple Sclerosis. Biomedicines 2022; 10:biomedicines10123260. [PMID: 36552016 PMCID: PMC9775954 DOI: 10.3390/biomedicines10123260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD) in asymptomatic patients with MS has been described in preliminary studies, but specific investigations of this topic are rare. Many authors advise early diagnosis and treatment of NLUTD in patients with MS. In contrast, clinical practice and different guidelines recommend neuro-urological diagnostics only in the presence of symptoms. Our aim was to investigate the characteristics of NLUTD and the correlations of clinical parameters with NLUTD in asymptomatic patients with MS. We evaluated bladder diaries, urodynamic findings, and therapy proposals. Correlations of the voided volume, voiding frequency, urinary tract infections, and uroflowmetry including post-void residual with the urodynamic findings were determined. In our study, 26% of the patients were asymptomatic. Of these, 73.7% had urodynamic findings indicative of NLUTD, 21.1% had detrusor overactivity, 13.2% had detrusor underactivity, 13.2% detrusor overactivity and detrusor sphincter dyssynergia, and 57.9% had radiologically abnormal findings of the bladder. No patients presented low bladder compliance or renal reflux. Clinical parameters from the bladder diary and urinary tract infections were found to be correlated with NLUTD, and the absence of symptoms did not exclude NLUTD in patients with MS. We observed that urinary tract damage is already present in a relevant proportion. Based on our results, we recommend that patients with MS be screened for NLUTD regardless of the subjective presence of urinary symptoms or the disease stage.
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Affiliation(s)
- Anke K. Jaekel
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany
- Correspondence: ; Tel.: +0049-179-9033123
| | - Franziska I. Winterhagen
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Federico L. Zeller
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany
| | - Anna-Lena Butscher
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany
| | - Franziska K. Knappe
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Franziska Schmitz
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Christopher Hauk
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Johannes Stein
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Ruth K. M. Kirschner-Hermanns
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany
| | - Stephanie C. Knüpfer
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
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Marzouk MH, Darwish MH, El-Tamawy MS, Morsy S, Abbas RL, Ali AS. Posterior tibial nerve stimulation as a neuromodulation therapy in treatment of neurogenic overactive bladder in multiple sclerosis: A prospective randomized controlled study. Mult Scler Relat Disord 2022; 68:104252. [PMID: 36274285 DOI: 10.1016/j.msard.2022.104252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/08/2022] [Accepted: 10/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND one of the major annoying disorders occurring in people with multiple sclerosis is lower urinary tract disorders (LUT). Urgency is considered the main one seriously influencing the quality of life. Neurogenic detrusor over activity (DOAB) is characterized by a hyperreflexic, overactive detrusor that responds quickly to low-intensity sensory input from general visceral afferent fibers. Overactivity has been claimed to induce random, uncontrolled contractions of the detrusor muscle, leading to intravesicular pressure rise, producing urgency, frequency, and consequently incontinence AIM: To demonstrate the therapeutic efficacy for posterior tibial nerve stimulation (PTNS) in neurogenic over active bladder (NOAB) in people with multiple sclerosis METHODS: The current trial is a prospective, randomized controlled study. Forty remitting relapsing males with MS with moderate NOAB symptoms were randomly assigned into two equal groups; control group (C) treated by selected therapeutic exercises program for strengthening pelvic floor muscles and an intervention group (ES) receiving an additional posterior tibial nerve electrical stimulation. Each session ranged from 45- 50 minutes, three days weekly for a month. Outcome measures were recorded before starting the treatment and after termination of the study intervention and included over active bladder symptoms score (OVBS) score, urodynamic parameters (uroflow, filling and voiding cystometry), and post voiding residual volume by abdominal ultrasound RESULTS: There was a significant improvement of all voiding parameters compared to baseline and the group C except frequency of urgency incontinence. A significant decrease was detected in post-treatment mean episodes number of nighttime frequency, urgency, urgency incontinence (1.65 ± 0.93, 1.2 ± 0.52 and 1.5 ± 0.76) respectively of the ES group compared to that of group C (3.05 ± 1.09, 2.25 ± 0.71 and 2.25 ± 1.06) (P < 0.01). There was a significant decrease in median post-treatment OVBS score 3 (3-3) compared to group C median score 5 (6-4). A statistically significant improvement was observed of all urodynamic parameters (bladder capacity and compliance, Detrusor overactivity (DO), maximum flow rate and post voidal residual volume in the ES group compared to the group C CONCLUSION: PTNS is a promising and potentially beneficial treatment option for NOAB symptoms in males with MS and superior to pelvic floor muscle training alone.
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Affiliation(s)
- Mohamed H Marzouk
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
| | - Moshera H Darwish
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
| | | | - Samer Morsy
- Department of Urology, Faculty of Medicine, Cairo University.
| | - Rami L Abbas
- Physical Therapy Department, Beirut Arab University.
| | - Ahmed S Ali
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
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Bientinesi R, Gavi F, Coluzzi S, Nociti V, Marturano M, Sacco E. Neurologic Urinary Incontinence, Lower Urinary Tract Symptoms and Sexual Dysfunctions in Multiple Sclerosis: Expert Opinions Based on the Review of Current Evidences. J Clin Med 2022; 11:6572. [PMID: 36362799 PMCID: PMC9657457 DOI: 10.3390/jcm11216572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/24/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To resume each specialist's role in the management of neurologic urinary tract symptoms (nLUTS) and sexual dysfunctions (SD) in patients suffering from multiple sclerosis (MS). MATERIAL AND METHODS We asked a neurologist, a urologist and a gynecologist, experts on neuro-urology and sexual dysfunction at our hospital, to resume their role in the management of nLUTS and SD in MS patients based on the review of current evidence. PubMed was used to review literature with a focus on nLUTS and SD in MS patients. CONCLUSIONS The difference in symptomatology in MS patients is very wide. The more the CNS is involved, the more the variations and severity of nLUTS is present. SD have numerous causes and should always be assessed. Urologists play the director's role in evaluating and treating these patients. Neurologist should play an important role, they must evaluate the potential mutual interactions between disease manifestations of MS and their treatments. Additionally, gynecologists play an important information sharing role in the management of patients with multiple sclerosis.
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Affiliation(s)
- Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Simone Coluzzi
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 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, 00168 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, 00168 Rome, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Hu Y, Lu W, Tang B, Zhao Z, An Z. Urinary incontinence as a possible signal of neuromuscular toxicity during immune checkpoint inhibitor treatment: Case report and retrospective pharmacovigilance study. Front Oncol 2022; 12:954468. [PMID: 36172143 PMCID: PMC9510979 DOI: 10.3389/fonc.2022.954468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are associated with different immune-related adverse events (irAEs), but there is limited evidence regarding the association between urinary incontinence and ICIs. Methods We described the case of a patient experiencing urinary incontinence who later experienced a series of irAEs such as myocarditis, myositis, and neurologic diseases while on ICI treatment in our hospital. In addition, we queried the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) from the third quarter of 2010 to the third quarter of 2020 to perform a retrospective study to characterize the clinical features of urinary incontinence associated with ICIs. Result In the FAERS study, 59 cases of ICI-related urinary incontinence were retrieved, and approximately 32.2% of the cases were fatal. Combination therapy with nervous system drugs and age >80 years old were the significant risk factors for fatal outcomes. Among these cases of ICI-related urinary incontinence, 40.7% (n = 24) occurred concomitantly with other adverse events, especially, neurological (fifteen cases), cardiovascular (seven cases), musculoskeletal (six cases), and urological disorders (five cases). Five cases had an overlapping syndrome similar to our case report, including one case of myasthenia gravis with myocarditis and another of myasthenic syndrome with polymyositis. Conclusion ICI-related urinary incontinence might be a signal of fatal neuromuscular irAEs, especially when it occurs concomitantly with ICI-associated neuromuscular–cardiovascular syndrome. Clinicians should be aware of the occurrence of urinary incontinence to identify potentially lethal irAEs in the early phase.
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Affiliation(s)
- Yizhang Hu
- Department of Oncology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Wenchao Lu
- Department of Pharmacy, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Borui Tang
- Department of Pharmacy, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhixia Zhao
- Department of Pharmacy Clinical Trial Research Center, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Zhixia Zhao, ; Zhuoling An,
| | - Zhuoling An
- Department of Pharmacy, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhixia Zhao, ; Zhuoling An,
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Talebi M, Pourmohammad A, Tayebi S, Talebi M, Farhoudi M, Moazed R, Salehi-Pourmehr H, Hajebrahimi S. Psychometric properties of the Persian version of neurogenic bladder symptom score questionnaire: A methodological study on patients with multiple sclerosis and stroke. Neurourol Urodyn 2022; 41:1817-1823. [PMID: 36047391 DOI: 10.1002/nau.25029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Concerning the impact of neurogenic lower urinary tract dysfunction (NLUTD) on quality of life, besides the lack of standard psychometrically-analyzed Persian tools, the present study investigated the validity and reliability of the Persian version of the neurogenic bladder symptom score (NBSS) questionnaire. METHODS A total of 279 multiple sclerosis (MS) or stroke/cerebrovascular accident (CVA) patients over 18 years of age with NLUTD referred to the neurology clinics entered the study in 2021-2022. After translation, back-translation, and developing a Persian version, its validity and reliability were determined. The content validity index (CVI) and content validity ratio (CVR) were calculated quantitatively. To determine the internal consistency and scale reliability, a test-retest was used. RESULTS The Cronbach's α coefficient was 0.83 and the intraclass correlation coefficient (95% confidence interval) was 0.85 (0.82, 0.88). Cronbach's α in all domains (incontinence, storage and voiding, and consequence) was greater than 0.70. The criterion validity also showed a positive correlation of NBSS with the International Consultation on Incontinence Questionnaire-overactive bladder (p < 0.001 and r = 0.55). The face validity was acceptable according to the opinion of 10 participants. To determine the CVI and the CVR, 10 experts' panels reviewed all items related to the questionnaire in terms of necessity, clarity, transparency, and relevancy. Based on the expert panel all NBSS criteria got a high score, and all criteria were essential to assess NLUTD (CVI: 0.78-1). CONCLUSIONS Regarding validity and reliability, the Persian version NBSS questionnaire can properly evaluate NLUTD in MS or stroke/CVA patients.
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Affiliation(s)
- Mahnaz Talebi
- Neurosciences Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Pourmohammad
- Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sona Tayebi
- Urology Department, Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran
| | - Maliheh Talebi
- Neurosciences Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Farhoudi
- Neurosciences Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Raha Moazed
- Department of Interdisciplinary Studies, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran.,Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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10
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Abakay H, Doğan H, Yetkin MF, Güç A, Talay Çaliş H, Demir Çaltekin M. The effects of incontinence on functionality, disability, and quality of life in male and female patients with multiple sclerosis. Mult Scler Relat Disord 2022; 66:104010. [PMID: 35849991 DOI: 10.1016/j.msard.2022.104010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the effects of incontinence on male and female patients with multiple sclerosis in terms of functionality, disability, and quality of life. METHODS The study included 90 patients (45 male, 45 female) with multiple sclerosis (MS) with a median age of 37 years. After recording the sociodemographic characteristics, urinary incontinence was evaluated in terms of quality of life with the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), overactive bladder symptoms with Overactive Bladder Questionnaire-V8 (OAB-V8), quality of life with Multiple Sclerosis Quality of Life Questionnaire-54 (MSQOL-54), and function was evaluated with the Lower Extremity Functional Scale (LEFS). RESULTS The demographic and clinical features, types of incontinence, total and sub-dimensions of ICIQ-SF, LEFS, OAB-V8, MSQOL-54 were determined to be similar in both males and females with MS (p>0.05). The education level of males was higher than that of females (p<0.05). A positive correlation was found between the mean LEFS score and MSQOL-total, MSQOL-PHC(physical health composite) and MSQOL-MHC(mental health composite) scores, and a negative correlation was found between the mean LEFS score and the ICIQ-SF and OAB-V8 scores (p<0.05). CONCLUSION Urinary incontinence, overactive bladder and lower extremity functionality may be similar in males and females with MS. It should not be ignored that lower extremity functionality may negatively affect incontinence symptoms.
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Affiliation(s)
- Hanife Abakay
- Sarıkaya School of Physiotherapy and Rehabilitation, Yozgat Bozok University, Yozgat,Turkey.
| | - Hanife Doğan
- Sarıkaya School of Physiotherapy and Rehabilitation, Yozgat Bozok University, Yozgat,Turkey
| | - M Fatih Yetkin
- Faculty of Medicine, Internal Medicine, Department of Neurology, Erciyes University, Kayseri, Turkey
| | - Ayşe Güç
- Physical Therapy and Rehabilitation Hospital, Kayseri City Hospital, Kayseri, Turkey
| | - Havva Talay Çaliş
- Physical Therapy and Rehabilitation Hospital, Kayseri City Hospital, Kayseri, Turkey
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Sparaco M, Bonavita S. Pelvic Floor Dysfunctions and Their Rehabilitation in Multiple Sclerosis. J Clin Med 2022; 11:jcm11071941. [PMID: 35407549 PMCID: PMC8999571 DOI: 10.3390/jcm11071941] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022] Open
Abstract
Urinary, bowel, and sexual dysfunctions are the most frequent and disabling pelvic floor (PF) disorders in patients with multiple sclerosis (MS). PF dysfunction negatively impacts the performance of daily living activities, walking, and the physical dimension of quality of life (QoL) in people with MS. Patient-reported outcomes on sphincteric functioning could be useful to detect PF disorders and their impact on patients’ lives. PF rehabilitation proposed by Kegel is based on a series of regularly repeated exercises for “the functional restoration of the perineal muscles”. Over time, various therapeutic modalities have been added to PF muscles exercises, through the application of physical or instrumental techniques, such as intravaginal neuromuscular electrical stimulation, electromyographic biofeedback, transcutaneous tibial nerve stimulation. PF rehabilitation has been applied in MS treatment, with improvements of lower urinary tract symptoms severity, QoL, level of anxiety and depression, and sexual dysfunction. This review aims to examine the different PF disorders in MS to evaluate the application of PF rehabilitation in MS and to highlight its advantages and limits, suggesting a multidisciplinary management of PF disorders, with a well-deserved space reserved for PF rehabilitation.
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Affiliation(s)
| | - Simona Bonavita
- Correspondence: ; Tel.: +39-081-5666742; Fax: +39-081-5665096
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12
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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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Kajbafvala M, Ashnagar Z, Lucio A, Firoozeh F, Salehi R, Pashazadeh F, Dadgoo M, Jafari H. Pelvic floor muscle training in multiple sclerosis patients with lower urinary tract dysfunction: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 59:103559. [DOI: 10.1016/j.msard.2022.103559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 01/10/2023]
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14
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Erden E, Ersöz M, Tiftik T, Erden E. The neurogenic bladder characteristics and treatment approaches in the patients with multiple sclerosis. Mult Scler Relat Disord 2021; 58:103439. [PMID: 34954652 DOI: 10.1016/j.msard.2021.103439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To analyze the neurogenic bladder characteristics and the treatment approaches in patients with multiple sclerosis (MS) to facilitate proper and reasonable decisions in relevant patients. DESIGN Retrospective study. SETTING Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey. PARTICIPANTS Seventy-five patients diagnosed with MS between 2002 and 2015 were included in the study. INTERVENTION Urodynamic examination. OUTCOME MEASURE The detrusor type, detrusor compliance, sense of bladder fullness, storage disorder, emptying disorder, voided volume, post-void residual volume, urine culture, emptying method, and medical treatments were recorded. RESULTS The study included 53 females and 22 males with a mean age of 36 ± 10.1 years. Urodynamic examinations indicated that 74.7% of the patients had detrusor overactivity, 74.7% had detrusor hypocompliance, 77.3% had storage dysfunction, and 81.3% had emptying dysfunction. An anticholinergic medication was recommended to 74.7% of the patients, while alpha-adrenergic receptor blockers were recommended to 69.3%. The detrusor hypocompliance was more common in the group with a disease duration of ≥10 years (p = 0.045). The use of external collector systems was more common, and urine culture was more frequently positive for infections in the female patients (p = 0.001 and p = 0.049, respectively). The frequency of normal bladder-filling sensation was higher in women (p = 0.01). The frequencies of detrusor overactivity and storage and emptying disorders, voided and postvoid volumes (mL), and bladder emptying methods were not significantly different among the subgroups (p > 0.05). CONCLUSION The study revealed a significant neurogenic bladder dysfunction and an inadequate management of this dysfunction in MS patients. Considering that the symptoms may progress over time, the urinary systems of MS patients should be evaluated periodically, and necessary modifications should be made in their treatments.
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Affiliation(s)
- Ender Erden
- The Department of Physical Medicine and Rehabilitation, Hitit University School of Medicine, Çorum, Turkey
| | - Murat Ersöz
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Tülay Tiftik
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ebru Erden
- Department of Physical Medicine and Rehabilitation, Erol Olçok Training and Research Hospital, Hitit University, Çorum, Turkey.
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Matsuo T, Nakamura T, Sato K, Miyata Y, Sakai H. Intravesical injection of onabotulinumtoxinA in neurogenic overactive bladder patients with human T-cell leukemia virus type 1-associated myelopathy: A single-institution case series. IJU Case Rep 2021; 4:251-254. [PMID: 34258542 PMCID: PMC8255280 DOI: 10.1002/iju5.12301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/26/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Neurogenic overactive bladder is a main feature of human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis. We successfully performed intravesical onabotulinumtoxinA therapy for refractory neurogenic overactive bladder due to human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis. CASE PRESENTATION We retrospectively reviewed four neurogenic overactive bladder patients with human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis who underwent bladder wall injections of onabotulinumtoxinA from April to October 2020. All patients were female. Their median age was 66 (range, 63-71) years. They were previously treated with β3-adrenergic receptor agonists or anticholinergic drugs alone or in combination for ≥12 weeks. However, insufficient results were obtained. After 4 weeks of intravesical onabotulinumtoxinA therapy, overactive bladder symptoms improved and maximum cystometric capacity increased in all cases. CONCLUSION Intravesical onabotulinumtoxinA therapy may be useful for treating refractory overactive bladder due to human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis.
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Affiliation(s)
- Tomohiro Matsuo
- Department of UrologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Tatsufumi Nakamura
- Department of Social WorkFaculty of Human and Social StudiesNagasaki International UniversitySaseboJapan
| | - Katsuya Sato
- Department of Locomotive Rehabilitation ScienceUnit of Rehabilitation SciencesNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Yasuyoshi Miyata
- Department of UrologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hideki Sakai
- Department of UrologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
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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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17
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Raza-Khan F. Basic Evaluation of Urinary Incontinence. Clin Obstet Gynecol 2021; 64:276-286. [PMID: 33882521 DOI: 10.1097/grf.0000000000000617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Urinary incontinence is a significant, quality of life health condition affecting millions of women. Incontinence is increasingly common as the population ages, and women present with varying degrees of bother. With basic in-office evaluation, most subtypes of urinary incontinence can be defined, evaluated, and treated. Basic in-office evaluation involves a detailed history with a review of current medical problems and medications, a physical examination, and selective in-office testing.
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Affiliation(s)
- Fareesa Raza-Khan
- Female Pelvic Medicine and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
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18
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Interplay Between Cognitive and Bowel/Bladder Function in Multiple Sclerosis. Int Neurourol J 2021; 25:310-318. [PMID: 33957715 PMCID: PMC8748300 DOI: 10.5213/inj.2040346.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/29/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose The aim of this study was to evaluate the prevalence of bowel/bladder dysfunction in multiple sclerosis (MS) and its associations with cognitive impairment. Methods We prospectively enrolled 150 MS patients. Patients were administered the Symbol Digit Modality Test (SDMT), the Neurogenic Bowel Dysfunction Score (NBDS), and the Actionable Bladder Symptom Screening Tool (ABSST). The associations between bowel/bladder dysfunction and cognitive function were assessed through hierarchical regression models using the SDMT and clinicodemographic features as independent variables and NBDS and ABSST scores as dependent variables. Results The prevalence of bowel/bladder deficits was 44.7%, with 26 patients (17.3%) suffering from bowel deficits and 60 patients (40%) from bladder deficits. The total NBDS and ABSST scores were correlated with the SDMT (β=-0.10, P<0.001 and β=-0.03, P=0.04, respectively) after correction for demographic features and physical disability. Conclusions Bowel/bladder disorders are common in MS and are associated with both physical and cognitive disability burdens. As SDMT is embedded into routine clinical assessments, a lower score may warrant investigating bowel/bladder dysfunction due to the strong interplay of these factors.
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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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20
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Ramasamy R, Smith PP. Animal modeling of lower urinary tract dysfunction associated with multiple sclerosis: Part I: Justification of the mouse model for MS research. Neurourol Urodyn 2021; 40:950-957. [PMID: 33719097 DOI: 10.1002/nau.24649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/23/2020] [Accepted: 01/16/2021] [Indexed: 12/20/2022]
Abstract
Lower urinary tract symptoms and dysfunction (LUTS/LUTD) contribute to loss of quality of life, morbidity, and need for medical intervention in most patients with multiple sclerosis (MS). Although MS is an inflammatory neurodegenerative disease, clinical manifestations including continence control disorders have traditionally been attributed to the loss of neural signaling due to neurodegeneration. Clinical approaches to MS-LUTS/LUTD have focused on addressing symptoms in the context of urodynamic dysfunctions as pathophysiologic understandings are incomplete. The mouse model provides a useful research platform for the discovery of more detailed molecular, cellular, and tissue-level knowledge of the disease and its clinical manifestations. The aim of this two-part review is to provide a state-of-the-art update on the use of the mouse model for MS research, with a focus on lower urinary tract symptoms. Part I presents a summary of the current understanding of MS pathophysiology, the impact on lower urinary tract symptoms, and briefly introduces the types of mouse models available to study MS. Part II presents the common animal models that are currently available to study MS, their mechanism, relevance to MS-LUTS/LUTD and their urinary pathophysiology, advantages, and disadvantages.
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Affiliation(s)
- Ramalakshmi Ramasamy
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA.,Department of Neuroscience, University of Connecticut Graduate School, Farmington, Connecticut, USA.,CT Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Phillip P Smith
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA.,Department of Neuroscience, University of Connecticut Graduate School, Farmington, Connecticut, USA.,CT Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut, USA.,Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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21
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Abstract
IMPORTANCE Multiple sclerosis (MS) is an autoimmune-mediated neurodegenerative disease of the central nervous system characterized by inflammatory demyelination with axonal transection. MS affects an estimated 900 000 people in the US. MS typically presents in young adults (mean age of onset, 20-30 years) and can lead to physical disability, cognitive impairment, and decreased quality of life. This review summarizes current evidence regarding diagnosis and treatment of MS. OBSERVATIONS MS typically presents in young adults aged 20 to 30 years with unilateral optic neuritis, partial myelitis, sensory disturbances, or brainstem syndromes such as internuclear ophthalmoplegia developing over several days. The prevalence of MS worldwide ranges from 5 to 300 per 100 000 people and increases at higher latitudes. Overall life expectancy is less than in the general population (75.9 vs 83.4 years), and MS more commonly affects women (female to male sex distribution of nearly 3:1). Diagnosis is made based on a combination of signs and symptoms, radiographic findings (eg, magnetic resonance imaging [MRI] T2 lesions), and laboratory findings (eg, cerebrospinal fluid-specific oligoclonal bands), which are components of the 2017 McDonald Criteria. Nine classes of disease-modifying therapies (DMTs), with varying mechanisms of action and routes of administration, are available for relapsing-remitting MS, defined as relapses at onset with stable neurologic disability between episodes, and secondary progressive MS with activity, defined as steadily increasing neurologic disability following a relapsing course with evidence of ongoing inflammatory activity. These drugs include interferons, glatiramer acetate, teriflunomide, sphingosine 1-phosphate receptor modulators, fumarates, cladribine, and 3 types of monoclonal antibodies. One additional DMT, ocrelizumab, is approved for primary progressive MS. These DMTs reduce clinical relapses and MRI lesions (new T2 lesions, gadolinium-enhancing lesions). Efficacy rates of current DMTs, defined by reduction in annualized relapse rates compared with placebo or active comparators, range from 29%-68%. Adverse effects include infections, bradycardia, heart blocks, macular edema, infusion reactions, injection-site reactions, and secondary autoimmune adverse effects, such as autoimmune thyroid disease. CONCLUSIONS AND RELEVANCE MS is characterized by physical disability, cognitive impairment, and other symptoms that affect quality of life. Treatment with DMT can reduce the annual relapse rate by 29% to 68% compared with placebo or active comparator.
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Affiliation(s)
| | | | - Alexander D Rae-Grant
- Cleveland Clinic Mellen Center, Cleveland, Ohio
- Now with Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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22
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El Helou E, Sarkis J, Mjaess G, Zalaket J, Mouawad C, Sayegh N, Ghattas S, Azar C, El Helou J, Abboud H, Koussa S, Nemr E. Urodynamics in patients with multiple sclerosis: is it necessary? A randomized-controlled trial. Scand J Urol 2021; 55:161-168. [PMID: 33565359 DOI: 10.1080/21681805.2021.1879930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The need for complete urodynamic evaluation in Multiple Sclerosis (MS) patients with Lower Urinary Tract Symptoms (LUTS) is not fully established in the literature. The objective was to evaluate the effect of urodynamics in MS patients with LUTS on treatment outcomes. METHODS MS patients with LUTS were recruited. On their first visit, urinary symptoms, symptom bother and urologic quality-of-life were evaluated using standardized questionnaires. On their second visit, patients were randomized into two groups: Group A underwent uroflowmetry, and Group B underwent a urodynamic study. Patients received treatment based on the whole evaluation and then were evaluated at 1, 3 and 6 months. RESULTS Fifty MS patients with LUTS were randomized to 25 patients in each group. All scores decreased significantly after 6 months of treatment in both groups (p < 0.05). However, no differences were found between the two groups at baseline and at 1, 3 and 6 months of treatment (p > 0.05) concerning treatment outcomes. CONCLUSION A detailed clinical and non-invasive evaluation of MS patients with LUTS seems to be sufficient for prescribing an effective treatment. A urodynamic study does not influence the response to the prescribed treatment in terms of LUTS severity, bother or urologic quality-of-life.
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Affiliation(s)
- Elie El Helou
- Department of Urology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Julien Sarkis
- Department of Urology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Georges Mjaess
- Faculty of Medicine, Saint, Joseph University, Beirut, Lebanon
| | - Jad Zalaket
- Faculty of Medicine, Saint, Joseph University, Beirut, Lebanon
| | | | - Nicolas Sayegh
- Faculty of Medicine, Saint, Joseph University, Beirut, Lebanon
| | - Souad Ghattas
- Faculty of Medicine, Saint, Joseph University, Beirut, Lebanon
| | - Carine Azar
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jeanine El Helou
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Halim Abboud
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Salam Koussa
- Department of Neurology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elie Nemr
- Department of Urology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Liu B, Ding Y, Li P, Wang T, He S, Jia Z, Yang J. MicroRNA-219c-5p regulates bladder fibrosis by targeting FN1. BMC Urol 2020; 20:193. [PMID: 33287818 PMCID: PMC7720614 DOI: 10.1186/s12894-020-00765-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/30/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND We found that the bladders of multiple sclerosis mice were significantly fibrotic. This study aimed to investigate the relationship between fibronectin 1 (FN1) and bladder fibrosis, as well as the microRNAs involved in FN1 regulation. METHODS The degree of bladder smooth muscle fibrosis was observed by immunohistochemistry. In addition, we used quantitative real-time polymerase chain reaction (RT-qPCR) and Western blotting to determine FN1 expression in bladders with different grades of fibrosis. Bioinformatics analysis revealed that miR-199a-3p, miR-219c-5p and miR-3572-3p could inhibit FN1 synthesis. Therefore, miR-199a-3p, miR-219c-5p and miR-3572-3p were overexpressed or knocked down in bladder smooth muscle cells (BSMCs), and the respective transfection and FN1 knockdown efficiencies were detected by RT-qPCR. Only miR-219c-5p overexpression and knockdown produced the expected results. A dual luciferase reporter assay was used to determine the targeting relationship between miR-219c-5p and FN1. Flow cytometry and Cell Counting Kit 8 (CCK8) experiments confirmed that miR-219c-5p reduced FN1 expression and affected the biological activity of smooth muscle cells. Agomir and anagomir of miR-219c-5p were transfected in vivo to observe the change of bladder fibrosis in mice. RESULTS With increasing bladder fibrosis, FN1 expression increased, while miR-199a-3p, miR-219c-5p, and miR-3572-3p expression levels decreased. The RT-qPCR results after transfection showed that only miR-219c-5p could regulate FN1. Indeed, the dual luciferase reporter assay results indicated that miR-219c-5p targeted FN1 directly. CCK8 and cell cycle assays showed that miR-219c-5p overexpression inhibited BSMC proliferation, while miR-219c-5p knockdown promoted BSMC proliferation. An apoptosis assay showed that miR-219c-5p overexpression promoted apoptosis, while miR-219c-5p knockdown inhibited BSMC apoptosis. The agomir and anagomir transfected with miR-219c-5p in vivo found that the bladder fibrosis of the mice in the agomir group was reduced, and the anagomir group was worse. CONCLUSIONS Our findings indicate that FN1 up-regulation and miR-219c-5p down-regulation play an important role in the development of bladder fibrosis, and miR-219c-5p participates in bladder fibrosis by regulating FN1 expression. Thus, a novel antifibrotic function of miR-219c-5p is proposed, which may represent a potential target for the diagnosis and treatment of bladder fibrosis.
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Affiliation(s)
- Bowen Liu
- Department of Urology, Zhengzhou University First Affiliated Hospital, Zhengzhou, 450052, China.,Zhengzhou Institute of Urology, Zhengzhou University First Affiliated Hospital, Zhengzhou, 450052, China
| | - Yafei Ding
- Department of Urology, Zhengzhou University First Affiliated Hospital, Zhengzhou, 450052, China
| | - Peng Li
- Department of Urology, Zhengzhou University First Affiliated Hospital, Zhengzhou, 450052, China
| | - Tao Wang
- Department of Urology, Zhengzhou University First Affiliated Hospital, Zhengzhou, 450052, China
| | - Siyuan He
- Department of Urology, Zhengzhou University First Affiliated Hospital, Zhengzhou, 450052, China
| | - Zhankui Jia
- Department of Urology, Zhengzhou University First Affiliated Hospital, Zhengzhou, 450052, China.,Zhengzhou Institute of Urology, Zhengzhou University First Affiliated Hospital, Zhengzhou, 450052, China
| | - Jinjian Yang
- Department of Urology, Zhengzhou University First Affiliated Hospital, Zhengzhou, 450052, China. .,Zhengzhou Institute of Urology, Zhengzhou University First Affiliated Hospital, Zhengzhou, 450052, China.
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Comparison of Lower Urinary System Symptoms of Women with Multiple Sclerosis and Healthy. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.781617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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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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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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Garrod H, Drybrough J, Khadr RN, Floyd MS. The reorganisation of a dedicated neurourology service: An interim review. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819872920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Neuropathic bladder and urinary system pathology, such as incontinence and stone formation, are the most frequently encountered complications of spinal cord injury (SCI) and neurological disease. This study assesses the patient population and current practice at a tertiary UK neurourology service following dedicated clinic restructuring in 2017. Methods: A retrospective database was created to assess all patients attending the neurourology clinic over an 8-month period. The database recorded patient demographics, pathologies and subsequent investigations and management. Clinical innovations such as dedicated patient questionnaires and the formation of a dedicated multidisciplinary team, and their subsequent impacts on service improvement, were also assessed. Results: A total of 99 patients attended the clinic during the study. The most common pathology was SCI (51.5% (51)). The most common complaints were continence and catheter issues (61.6% (61)). Urinary symptoms such as frequency (15.2% (15)), infection (13.1% (13)) and urinary tract stones (9.1% (9)) accounted for the remainder of presenting complaints. Operative intervention was required in 25.3% (25) of cases. Conclusion: Patients with SCI and neurological disease experience a range of urinary symptoms with significant morbidity. Ensuring upper tract integrity, safe bladder management and intervening when necessary to improve quality of life are important concerns for the neurourologist. The redesigning of a dedicated neurourology clinic has permitted the treatment of such patients with a systematic approach ensuring safe bladder monitoring and upper tract surveillance. The introduction of a validated patient-reported symptom score has helped objective monitoring of symptoms before and after specific interventions. Patient concerns regarding sexual function and fertility are increasingly being encountered and addressed in the clinic. Level of evidence: 4
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Affiliation(s)
- Huw Garrod
- Departments of Urology, Southport & Ormskirk NHS Foundation Trust, UK
| | - Joe Drybrough
- Departments of Urology, Southport & Ormskirk NHS Foundation Trust, UK
| | - Rauf N Khadr
- Departments of Urology, Southport & Ormskirk NHS Foundation Trust, UK
- North West Spinal Cord Injury Unit, Southport & Ormskirk NHS Foundation Trust, UK
| | - Michael S Floyd
- Departments of Urology, Southport & Ormskirk NHS Foundation Trust, UK
- North West Spinal Cord Injury Unit, Southport & Ormskirk NHS Foundation Trust, UK
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Khavari R, Chen J, Boone T, Karmonik C. Brain activation patterns of female multiple sclerosis patients with voiding dysfunction. Neurourol Urodyn 2020; 39:969-977. [PMID: 32032447 DOI: 10.1002/nau.24304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/23/2020] [Indexed: 12/20/2022]
Abstract
AIMS We compared brain activation patterns between female multiple sclerosis (MS) patients with voiding dysfunction (VD) and those without. We aim to expand current knowledge of supraspinal correlates of voiding initiation within a cohort of female MS patients with and without VD. MATERIALS AND METHODS Twenty-eight ambulatory female MS patients with stable disease and lower urinary tract dysfunction were recruited for this study. Subjects were divided into group 1, without VD (n = 14), and group 2, with VD (n = 14), defined as postvoid residual urine of ≥40% of maximum cystometric capacity or need for self-catheterization. We recorded brain activity via functional magnetic resonance imaging (fMRI) with simultaneous urodynamic testing. Average fMRI activation maps (the Student t test) were created for both groups, and areas of significant activation were identified (P < .05). A priori regions of interest (ROIs), identified by prior meta-analysis to be involved in voiding, were selected. RESULTS Group-averaged blood-oxygen level-dependent (BOLD) activation maps demonstrated significant differences between groups 1 and 2 during initiation of voiding with group 2 showing significantly lower levels of activation in all ROIs except for the left cerebellum and right cingulate gyrus. Interestingly, group 2 displayed negative BOLD signals, while group 1 displayed positive signals in the right and left pontine micturition center, right periaqueductal gray, left thalamus, and left cingulate gyrus. The activation map of group 1 was similar to healthy controls. CONCLUSIONS Our results support the hypothesis that distinct supraspinal activation patterns exist between female MS patients with VD and those without.
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Affiliation(s)
- Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Jessie Chen
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Timothy Boone
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Christof Karmonik
- MRI Core, Research Institute, Houston Methodist Hospital, Houston, Texas
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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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Nazari F, Shaygannejad V, Mohammadi Sichani M, Mansourian M, Hajhashemi V. The prevalence of lower urinary tract symptoms based on individual and clinical parameters in patients with multiple sclerosis. BMC Neurol 2020; 20:24. [PMID: 31952513 PMCID: PMC6966887 DOI: 10.1186/s12883-019-1582-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background Most patients with multiple sclerosis (MS) suffer from bladder dysfunction during the course of the disease. This study was conducted to examine the prevalence of these complications among patients with MS. Methods This cross-sectional study was performed on 602 patients with MS who referred to the neurology clinics of Kashani and Alzahra Hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Multistage random cluster sampling was performed and the informed consent form was signed by the subjects. Then, all the data were collected through interviews using the Lower Urinary Tract Symptom Score (LUTSS) developed in accordance with the definitions presented by the International Continence Society (ICS) and the International Prostate Symptom Score (I-PSS) and DASS-21 questionnaire. The data were analyzed using descriptive and inferential statistical tests in SPSS. Results The prevalence rate of lower urinary tract symptoms (LUTS) was 87.6% among all the subjects, with a similar rate among women (88.0%) and men (86.0%). There was a significant difference between men and women in terms of the prevalence of stress urinary incontinence (SUI), intermittent urine flow, hesitancy, straining, and dribbling (P < 0.050). There was no significant difference between women and men in terms of the prevalence of other symptoms (P > 0.050). A significant difference was observed in the degree of LUTS with age, marital status, marriage duration, education, illness duration, clinical course, disability, anxiety, depression, and stress (P< 0.05). Moreover, logistic regression analysis revealed that there was a higher probability of a urinary problems among patients with MS and a high EDSS score [0.67 (0.507–0.903), P = 0.008]. Conclusions A high prevalence of LUTS was found among patients with MS. There was a higher probability of a urinary tract problem among patients with MS and a high EDSS score. Therefore, it is recommended that the health system take the necessary measures regarding timely detection and treatment of LUTS among these patients in order to prevent secondary outcomes and improve the quality of life (QOL) of patients with MS.
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Affiliation(s)
- Fatemeh Nazari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. .,Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mehrdad Mohammadi Sichani
- Isfahan Kidney Transplantation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology & Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Valiollah Hajhashemi
- Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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31
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Medina-Polo J, Adot JM, Allué M, Arlandis S, Blasco P, Casanova B, Matías-Guiu J, Madurga B, Meza-Murillo ER, Müller-Arteaga C, Rodríguez-Acevedo B, Vara J, Zubiaur MC, López-Fando L. Consensus document on the multidisciplinary management of neurogenic lower urinary tract dysfunction in patients with multiple sclerosis. Neurourol Urodyn 2020; 39:762-770. [PMID: 31943361 DOI: 10.1002/nau.24276] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/30/2019] [Indexed: 11/07/2022]
Abstract
AIM Neurogenic lower urinary tract dysfunction (NLUTD) is very common in multiple sclerosis (MS) patients. Early diagnosis and treatment are crucial to avoid irreversible damage and improve quality of life. Our aim was to develop recommendations to improve NLUTD identification in MS patients, along with their referral and management. METHODS A multidisciplinary group of 14 experts in the management of patients with MS and NLUTD (nine urologists, three neurologists, and two rehabilitators) was selected. A comprehensive review of the literature was undertaken and a set of recommendations was generated and submitted to a Delphi panel of 114 experts. Recommendations were presented according to the grade of agreement (GA). RESULTS Early diagnosis in asymptomatic patients with risk factors for complications is recommended (GA 94%). Postvoid residual volume should be measured if changes in urinary symptoms (GA 87%), preferably ultrasound-guided (GA 86%). Early referral to urologist is recommended if urinary incontinence (GA 91%), significant post-void residual volume (94%), quality of life impairment (GA 98%) and recurrent urinary infections (GA 97%). The initial evaluation should include physical examination (GA 99%) and urodynamics including cystometry (GA 89%), pressure-flow study (90%) and electromyography (GA 70%). The panel recommends multidisciplinary collaboration (GA 100%) with a rehabilitation specialist and trained nurses in the management of NLUTD (GA 99%). CONCLUSIONS Multidisciplinary management for patients with NLUTD due to MS is advised, including urologists, neurologists, rehabilitation, and nurses. Panel recommends early diagnosis with post-void residual volume in symptomatic patients before referring to urologist and urodynamics when referred.
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Affiliation(s)
- José Medina-Polo
- Urology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José María Adot
- Urology Service, Hospital Universitario de Burgos, Burgos, Spain
| | - Marta Allué
- Urology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Salvador Arlandis
- Urology Service, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pedro Blasco
- Urology Service, Hospital Universitario Virgen de Valme, Seville, Spain
| | - Bonaventura Casanova
- Unitat de Nauroinmunologia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jorge Matías-Guiu
- Neurology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Blanca Madurga
- Urology Service, Puerta del Mar University Hospital, Cádiz, Spain
| | - Edwin-Roger Meza-Murillo
- Centre d'Esclerosi Múltiple de Catalunya (CEM-cat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Breogán Rodríguez-Acevedo
- Centre d'Esclerosi Múltiple de Catalunya (CEM-cat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jesús Vara
- Rehabilitation and Physical Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Luis López-Fando
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction. Toxins (Basel) 2019; 11:toxins11120728. [PMID: 31847090 PMCID: PMC6950422 DOI: 10.3390/toxins11120728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/01/2022] Open
Abstract
Neurogenic and non-neurogenic urethral sphincter dysfunction are common causes of voiding dysfunction. Injections of botulinum toxin A (BoNT-A) into the urethral sphincter have been used to treat urethral sphincter dysfunction (USD) refractory to conventional treatment. Since its first use for patients with detrusor sphincter dyssynergia in 1988, BoNT-A has been applied to various causes of USD, including dysfunctional voiding, Fowler’s syndrome, and poor relaxation of the external urethral sphincter. BoNT-A is believed to decrease urethral resistance via paralysis of the striated sphincter muscle through inhibition of acetylcholine release in the neuromuscular junction. Recovery of detrusor function in patients with detrusor underactivity combined with a hyperactive sphincter also suggested the potential neuromodulation effect of sphincteric BoNT-A injection. A large proportion of patients with different causes of USD report significant improvement in voiding after sphincteric BoNT-A injections. However, patient satisfaction might not increase with an improvement in the symptoms because of concomitant side effects including exacerbated incontinence, urinary urgency, and over-expectation. Nonetheless, in terms of efficacy and safety, BoNT-A is still a reasonable option for refractory voiding function. To date, studies focusing on urethral sphincter BoNT-A injections have been limited to the heterogeneous etiologies of USD. Further well-designed studies are thus needed.
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Títoff IB, Titoff V, Scott TF. Is baseline routine renal ultrasound indicated for all MS patients? Postgrad Med J 2019; 96:194-196. [PMID: 31611266 DOI: 10.1136/postgradmedj-2019-136838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/19/2019] [Accepted: 09/30/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Most patients with multiple sclerosis (MS) develop multiple urological complaints due to hyperactive or hypoactive bladder, and may have detrusor-sphincter dyssynergia. Routine renal ultrasound (RUS) screening has been recommended for both symptomatic and asymptomatic MS patients; however, there is little data to support this practice. METHODS Prospectively screened consecutive MS clinic patients in 2016-2017 with functional systems scores (FSS) indicating moderate to severe neurogenic bladder symptoms (FSS bladder ≥2) were sent for RUS. We also screened for history of urinary tract infections. RESULTS 872 patients were screened between 3 September 2016 and 13 April 2017. 58 patients met inclusion criteria for RUS. 6 were excluded due to non-compliance with testing or unavailability of results; 52 patients were imaged. Only 3/52 patients were found to have renal pathology requiring follow-up. Of those three, one had known symptomatic nephrolithiasis, and one had subsequently normal findings, leaving one patient newly found to have valid abnormal upper urinary tract (UUT) findings. Multiple incidental findings were also discovered. CONCLUSION The minimal yield for significant UUT pathology found in this enriched group of symptomatic MS patients indicates that RUS screening for asymptomatic MS patients without clear risk factors is not indicated. Red flags for high risk of UUT complications should be used as triggers for baseline RUS screening in MS patients.
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Affiliation(s)
- Igor B Títoff
- Neurology and Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Victoria Titoff
- Neurology and Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Thomas F Scott
- Neurology and Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Hartigan SM, Reynolds WS, Dmochowski RR. Detrusor underactivity in women: A current understanding. Neurourol Urodyn 2019; 38:2070-2076. [PMID: 31432566 DOI: 10.1002/nau.24147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/05/2019] [Indexed: 12/29/2022]
Abstract
AIMS To examine the current understanding and management of detrusor underactivity (DUA) and underactive bladder (UAB) in women. METHODS A review of the current literature was performed with a specific focus on new management strategies and treatment options for women with DUA and UAB. RESULTS DUA has become an area of increased interest in recent years. Affecting up to 45% of older women undergoing urodynamic evaluation for non-neurogenic lower urinary tract symptoms, DUA is common. There are a variety of possible etiologies including neurogenic or myogenic dysfunction. As there is currently no cure for DUA and no way to restore the ability of the detrusor muscle to contract, management of DUA in women is mostly focused on effective bladder drainage by urinary catheterization. Clean intermittent catheterization is the gold standard for bladder drainage however for a variety of reasons, women with DUA often are managed with indwelling urethral catheter or suprapubic tube. Medications, sacral neuromodulation, and the inFlow urinary prosthesis are also treatment alternatives or additions to catheterization. Novel therapies using stem cells and gene therapy are also under investigation for the treatment of DUA and UAB. CONCLUSIONS DUA is likely more prevalent than recognized and undertreated in women. It is vital that further research in treatment options beyond catheterization be developed for these patients to offer patients a variety of treatment options.
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Affiliation(s)
- Siobhan M Hartigan
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - W Stuart Reynolds
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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Lúcio A, Lourenço CB, Damasceno BP, de Moraes Lopes MHB, Dʼancona CAL. The Effect of Pelvic Floor Muscle Contraction on Detrusor Overactivity Pressure in Neurogenic and Nonneurogenic Women During Urodynamic Study: A Cross-Sectional Study. Am J Phys Med Rehabil 2019; 98:275-279. [PMID: 30893073 DOI: 10.1097/phm.0000000000001065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to investigate whether detrusor overactivity can be influenced by a pelvic floor muscle contraction in multiple sclerosis-associated overactive bladder and idiopathic overactive bladder volunteers and to compare urodynamic findings between the two groups. DESIGN Eighteen women with multiple sclerosis-associated overactive bladder and 17 women with overactive bladder responded the overactive bladder V8 questionnaire and performed urodynamic study with electromyography of pelvic floor muscle to confirm the presence of a 15-sec pelvic floor muscle contraction during a detrusor overactivity, when present. Variables were the following: overactive bladder-V8 questionnaire, maximum cystometric capacity, volume at first detrusor overactivity, maximum detrusor overactivity amplitude, and percentage of detrusor overactivity pressure reduction. RESULTS All participants had a reduction in detrusor overactivity pressure when pelvic floor muscle contraction was requested. Multiple sclerosis-associated overactive bladder group showed significant higher detrusor overactivity amplitude than overactive bladder group (P = 0.02). Overactive bladder group had their detrusor overactivity pressure reduced in a greater extent when compared with multiple sclerosis-associated overactive bladder group (P = 0.01). CONCLUSIONS The results suggest that pelvic floor muscle contraction is able to reduce detrusor overactivity pressure in multiple sclerosis-associated overactive bladder and overactive bladder population.
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Affiliation(s)
- Adélia Lúcio
- From the HUMAP - UFMS, Campo Grande - MS, Brazil (AL); University of Campinas - UNICAMP, Campinas, São Paulo, Brazil (AL, BPD, MHBdML, CALD); and Escola Superior de Ciência da Santa Casa de Misericórdia de Vitória - EMESCAM, Vitória, Espírito Santo, Brazil (CBL)
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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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Tibial Nerve and Sacral Neuromodulation in the Multiple Sclerosis Patient with Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0495-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cotterill N, Sullivan A, Norton C, Wilkins A, Weir I, Kilonzo M, Drake MJ. Conservative interventions for urinary or faecal incontinence, or both, in adults with multiple sclerosis. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nikki Cotterill
- North Bristol NHS Trust; Bristol Urological Institute; Southmead Hospital Bristol UK BS10 5NB
- CLAHRC West; The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; 9th Floor, Whitefriars Lewins Mead Bristol UK BS1 2NT
- University of the West of England; Centre for Health and Clinical Research, Faculty of Health and Applied Sciences; Blackberry Hill Bristol UK BS16 1DD
| | - Amanda Sullivan
- North Bristol NHS Trust; Department of Physiotherapy; Southmead Hospital, Southmead Road Bristol UK BS10 5NB
| | - Christine Norton
- King's College London; Adult Nursing, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care; 57 Waterloo Road London UK SE1 8WA
| | - Alastair Wilkins
- North Bristol NHS Trust; Bristol and Avon Multiple Sclerosis Unit/Clinical Neurosciences; Southmead Hospital, Southmead Road Bristol UK BS10 5NB
| | - Iain Weir
- University of West of England; Department of Engineering, Design and Mathematics; Coldharbour Lane Bristol UK BS16 1QY
| | - Mary Kilonzo
- University of Aberdeen; Health Economics Research Unit; Aberdeen UK AB25 2ZD
| | - Marcus J Drake
- University of Bristol; School of Clinical Sciences; Bristol UK BS10 5NB
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Torimoto K, Matsumoto Y, Gotoh D, Morizawa Y, Miyake M, Samma S, Tanaka N, Hirayama A, Fujimoto K. Overactive bladder induces transient hypertension. BMC Res Notes 2018; 11:196. [PMID: 29580270 PMCID: PMC5870500 DOI: 10.1186/s13104-018-3317-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/21/2018] [Indexed: 11/10/2022] Open
Abstract
Objectives Several studies have shown the relationship between lower urinary tract symptoms and autonomic imbalance. We investigated the relationship between detrusor overactivity (DO) or urgency, and transient increase in blood pressure as a type of hypertension related to sympathetic hyperactivity. Study 1: we enrolled 14 male patients with DO and 10 without DO. We measured the overactive bladder symptom score (OABSS) and blood pressure during cystometry. Study 2: we enrolled 14 men patients with overactive bladder (OAB) and 8 without OAB. We measured OABSS and blood pressure using a 24-h ambulatory device. Results Study 1: the mean systolic pressure was significantly higher at urgency or SDV than at the other measurement points in the DO group (161.3 ± 23.2 vs. 134.5 ± 16.3, 137.8 ± 15.3, or 139.5 ± 14.8 mmHg). Study 2: the mean systolic pressure was significantly higher at the measurement points before micturition than at the points unrelated to micturition in the OAB group (159.7 ± 24.9 vs. 124.9 ± 13.8 mmHg). In conclusion, DO or urgency induces a transient increase of blood pressure, suggesting that OAB induces a type of hypertension before micturition.
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Affiliation(s)
- Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yoshihiro Matsumoto
- Department of Urology, Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shoji Samma
- Department of Urology, Nara Prefecture General Medical Center, 1-30-1 Hiramatsu, Nara, Nara, 631-0846, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Akihide Hirayama
- Department of Urology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0227, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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40
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Review of underactive bladder. J Formos Med Assoc 2018; 117:178-184. [DOI: 10.1016/j.jfma.2017.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/29/2017] [Accepted: 09/07/2017] [Indexed: 12/13/2022] Open
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41
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Gomma HW, El-Azab AS. Developing a treatment for neurogenic bladder dysfunction using Model Predictive Control (MPC). Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2017.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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42
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Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors. Curr Opin Urol 2017; 27:293-299. [DOI: 10.1097/mou.0000000000000381] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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43
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Underactive bladder: Pathophysiology and clinical significance. Asian J Urol 2017; 5:17-21. [PMID: 29379731 PMCID: PMC5780287 DOI: 10.1016/j.ajur.2017.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 01/22/2017] [Accepted: 02/20/2017] [Indexed: 12/13/2022] Open
Abstract
Underactive bladder (UAB) is a voiding disorder which generates disabling lower urinary tract symptoms (LUTS) due to the inability to produce an effective voiding contraction sufficient to empty the bladder. The underlying abnormality, that is usually appreciated when performing urodynamic studies, has been defined by the International Continence Society (ICS) as detrusor underactivity (DUA). DUA is a common yet under-researched bladder dysfunction. The prevalence of DUA in different patient groups suggests that multiple aetiologies are implicated. Currently there is no effective therapeutic approach to treat this condition. An improved understanding of the underlying mechanisms is needed to facilitate the development of new advances in treatment. The purpose of this review is to discuss the epidemiology, pathophysiology, common causes and risk factors potentially leading to DUA; to aid in the appropriate diagnosis of DUA to potentially improve treatment outcomes.
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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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45
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Tracey JM, Stoffel JT. Secondary and tertiary treatments for multiple sclerosis patients with urinary symptoms. Investig Clin Urol 2016; 57:377-383. [PMID: 27847911 PMCID: PMC5109793 DOI: 10.4111/icu.2016.57.6.377] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/09/2016] [Indexed: 01/23/2023] Open
Abstract
Multiple sclerosis patients with refractory urinary symptoms after treatment with behavioral therapy and medications still have treatment options. Prior to starting treatments, baseline symptoms should be assessed and treatment goals thoroughly discussed. Catheterization, botulinum toxin, and reconstructive surgery all can play a role in improving both safety and quality of life for these patients. Newer modalities, such as neuromodulation, may also have an increasing role in the future as more data develop regarding efficacy. Risks need to be weighed against any perceived benefit and disease status before more aggressive therapy is initiated.
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Affiliation(s)
- James M Tracey
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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46
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Abstract
Underactive bladder (UAB) is a very common condition leading to disabling lower urinary tract symptoms. There has been an increasing interest in this condition as there is no effective treatment currently available. UAB has been described in many ways, but there is no agreed upon consensus on its terminology. The prevalence of UAB may be underestimated. This review focuses on the terminology, pathophysiology, common causes, its treatment, and future areas of research.
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Affiliation(s)
- Himanshu Aggarwal
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, J8 122, Dallas, TX, 75390-9110, USA
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, J8 122, Dallas, TX, 75390-9110, USA.
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47
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De Ridder D, Ost D, Van der Aa F, Stagnaro M, Beneton C, Gross-Paju K, Eelen P, Limbourg H, Harper M, Segal JC, Fowler CJ, Nordenbo A. Conservative bladder management in advanced multiple sclerosis. Mult Scler 2016; 11:694-9. [PMID: 16320730 DOI: 10.1191/1352458505ms1237oa] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anticholinergics and intermittent catheterization are the cornerstones of bladder management in early multiple sclerosis (MS). In advanced MS however, bladder management is based more on tradition than on evidence. Nurses seem to deal with catheter problems and chronic incontinence. Despite the abundant use of indwelling catheters, there is a lack for guidelines on catheter-induced problems. The psychosexual and social impact of bladder problems in advanced MS is often neglected. The international multidisciplinary special interest group on sexual, urological and bowel dysfunction in MS (SUBDIMS) as a special interest group of the Rehabilitation in Multiple Sclerosis (RIMS) was confronted with a high variability in practice and a lack of guidelines. A literature review was prepared during three multidisciplinary expert meetings. This review will be the basis of further initiatives to improve the urological treatment of patients with advanced MS.
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Affiliation(s)
- D De Ridder
- Department of Urology, University Hospitals KU Leuven, Belgium.
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48
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Nortvedt MW, Riise T, Frugård J, Mohn J, Bakke A, Skår AB, Nyland H, Glad SB, Myhr KM. Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis. Mult Scler 2016; 13:106-12. [PMID: 17294618 DOI: 10.1177/1352458506071210] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most multiple sclerosis (MS) patients experience some sexual, bladder and/or bowel dysfunction during the course of the disease - one of MS most disabling features. This study estimated the frequency of these problems among patients, two to five years after diagnosis, and investigated how these problems are associated with health-related quality of life (using the Multiple Sclerosis Quality of Life-54 questionnaire). The study population comprised a cohort of patients (n=56), diagnosed in a three-year period, in Hordaland County, Norway. The patients were examined clinically, including scoring of the Expanded Disability Status Scale (EDSS), and completed questionnaires related to bowel and bladder dysfunction, sexual problems and health-related quality of life. More than half the patients had bladder and sexual problems. The frequency of self-reported bladder problems corresponded to the relatively high levels of residual urine found. The presence of these problems was associated with lower scores on the quality of life scales. Further, the bowel problems reported were markedly associated with the quality of life scores. Since treatments and preventive strategies can manage many of these problems, we suggest increasing the focus on these aspects of the disease when consulting patients, including at early stages.
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Affiliation(s)
- M W Nortvedt
- Department of Health and Social Research, Bergen University College, PO Box 7030, N-5020 Bergen, Norway.
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49
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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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50
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Ghezzi A, Mutta E, Bianchi F, Bonavita S, Buttari F, Caramma A, Cavarretta R, Centonze D, Coghe GC, Coniglio G, Del Carro U, Ferrò MT, Marrosu MG, Patti F, Rovaris M, Sparaco M, Simone I, Tortorella C, Bergamaschi R. Diagnostic tools for assessment of urinary dysfunction in MS patients without urinary disturbances. Neurol Sci 2016; 37:437-42. [PMID: 26613723 DOI: 10.1007/s10072-015-2415-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
Many guidelines are available for the management of lower urinary tract symptoms (LUTSs) in multiple sclerosis (MS) patients, but no agreement exists on the best approach for subjects without LUTSs. The objective of this study was to evaluate whether LUTSs can be detected in MS patients asymptomatic for urinary dysfunction, comparing three different tools [measure of post-void residual volume (PRV), bladder diary (BD), a focused questionnaire (IPSS)], and whether disability, disease duration and signs of pyramidal involvement are linked to their subclinical presence. 178 MS patients (118 women) have been included (mean age 41.2 years, mean disease duration 11.3 years, mean EDSS 2.2), and tested with the above-mentioned tools. PRV was abnormal in 14 subjects (7.8%), associated to abnormal findings at IPSS in 3 cases, at BD in 2 cases, at both in 1. BD was abnormal in 37 subjects (20.8%), with concomitant abnormal PRV in 2, abnormal IPSS in 10 cases, abnormal IPSS and BD in 1. IPSS was ≥ 9 in 43 subjects (24.1%). At least one test was abnormal in 76 patients (42.7%): 1 in 57 patients (32.0%), 2 in 17 (9.5%), and 3 tests in 2 (1.1%). Patients with at least one abnormal urinary variable, compared to patients without urinary abnormalities, had a more frequent pyramidal involvement (69.5 vs. 16.8%, χ(2) = 48.6, p < 0.00001), a more frequent occurrence of EDSS ≥2 (83.1 vs. 23.5%, χ(2) = 56.9, p < 0.00001), and a longer disease duration (15.7 ± 7.3 vs. 9.1 ± 7.1, t = 5.7, p < 0.00001). Asymptomatic LUTS were frequent but none of the tests used permitted to better identify asymptomatic patients.
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Affiliation(s)
- A Ghezzi
- Neurologia 2-Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013, Gallarate, Italy.
| | - E Mutta
- Neurologia 2-Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013, Gallarate, Italy
| | - F Bianchi
- Divisione di Neurologia, Ospedale S. Raffaele Milano, Milan, Italy
| | - S Bonavita
- Clinica Neurologica, Università Federico II Napoli, Naples, Italy
| | - F Buttari
- Clinica Neurologica, Università Tor Vergata, Rome, Italy
| | - A Caramma
- Clinica Neurologica, Università di Catania, Catania, Italy
| | - R Cavarretta
- Centro Sclerosi Multipla, IRCCS Don Gnocchi, Milan, Italy
| | - D Centonze
- Clinica Neurologica, Università Tor Vergata, Rome, Italy
| | - G C Coghe
- Centro Sclerosi Multipla, Ospedale Binaghi, Cagliari, Italy
| | - G Coniglio
- Divisione di Neurologia, Ospedale S. Carlo, Matera, Italy
| | - U Del Carro
- Divisione di Neurologia, Ospedale S. Raffaele Milano, Milan, Italy
| | - M T Ferrò
- Divisione di Neurologia, Ospedale di Cremona, Cremona, Italy
| | - M G Marrosu
- Centro Sclerosi Multipla, Ospedale Binaghi, Cagliari, Italy
| | - F Patti
- Clinica Neurologica, Università di Catania, Catania, Italy
| | - M Rovaris
- Centro Sclerosi Multipla, IRCCS Don Gnocchi, Milan, Italy
| | - M Sparaco
- Clinica Neurologica, Università Federico II Napoli, Naples, Italy
| | - I Simone
- Clinica Neurologica, Università di Bari, Bari, Italy
| | - C Tortorella
- Clinica Neurologica, Università di Bari, Bari, Italy
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