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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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2
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Al Dandan HB, Coote S, McClurg D. Prevalence of Lower Urinary Tract Symptoms in People with Multiple Sclerosis: A Systematic Review and Meta-analysis. Int J MS Care 2020; 22:91-99. [PMID: 32410904 PMCID: PMC7204365 DOI: 10.7224/1537-2073.2019-030] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND No published study, to our knowledge, has systematically reviewed the prevalence estimates of lower urinary tract symptoms (LUTSs) and LUTS types in the general multiple sclerosis (MS) population. Therefore, a systematic review and a meta-analysis were conducted to determine the totality of literature investigating the prevalence of LUTSs and LUTS types in the general MS population according to International Continence Society definitions. METHODS Various electronic databases were searched between January 4, 2018, and February 12, 2018. This review included observational studies involving adults (18 years or older) with a confirmed diagnosis of MS recruited from the general MS population using self-report and/or objective outcome measures for LUTSs. RESULTS Twelve studies were included in the meta-analysis. The results showed that LUTSs were prevalent in people with MS, with a pooled prevalence of 68.41% using self-report and 63.95% using the objective measure of urodynamics. When considering LUTS types, urinary frequency was the predominant symptom, with a pooled prevalence estimate of 73.45%, followed by urgency assessed using self-report measures at 63.87%. Detrusor overactivity was found to be the most prevalent urodynamic symptom, with a pooled prevalence estimate of 42.9%, followed by detrusor sphincter dyssynergia at 35.44%. CONCLUSIONS This systematic review revealed that LUTSs are highly prevalent in MS. There is a need for improvement in the conduct and reporting of prevalence studies of LUTSs in MS and for the use of validated self-report outcome measures to enable pooling of data in the future.
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Lee S, Nedumaran B, Hypolite J, Caldwell B, Rudolph MC, Malykhina AP. Differential neurodegenerative phenotypes are associated with heterogeneous voiding dysfunction in a coronavirus-induced model of multiple sclerosis. Sci Rep 2019; 9:10869. [PMID: 31350464 PMCID: PMC6659655 DOI: 10.1038/s41598-019-47407-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/16/2019] [Indexed: 12/15/2022] Open
Abstract
Patients with multiple sclerosis (MS) develop a variety of lower urinary tract symptoms (LUTS). We previously characterized a murine model of neurogenic bladder dysfunction induced by a neurotropic strain of a coronavirus. In the present study, we further study the role of long-lasting neurodegeneration on the development of neurogenic bladder dysfunction in mice with corona-virus induced encephalitis (CIE). Long-term follow up study revealed three phenotypes of neurodegenerative symptom development: recovery (REC group), chronic progression (C-PRO group) and chronic disease with relapsing-remitting episodes (C-RELAP group). The levels of IL-1β in REC group, IL-10 in C-RELAP group, and IL-1β, IL-6, IL-10 and TNF-α in C-PRO group were diminished in the brain. The levels of TNF-α in REC group and INF-γ, IL-2, TGF-β and TNF-α in the C-PRO group were also diminished in the urinary bladder. Mice in C-RELAP group showed a delayed recovery of voiding function. In vitro contractility studies determined a decreased basal detrusor tone and reduced amplitude of nerve-mediated contractions in C-RELAP group, whereas C-PRO group had elevated muscle-mediated contractions. In conclusion, mice with CIE developed three phenotypes of neurologic impairment mimicking different types of MS progression in humans and showed differential mechanisms driving neurogenic bladder dysfunction.
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Affiliation(s)
- Sanghee Lee
- Department of Urology, University of California San Diego, La Jolla, California, USA
| | - Balachandar Nedumaran
- Division of Urology, Department of Surgery, University of Colorado Denver, Aurora, Co, USA
| | - Joseph Hypolite
- Division of Urology, Department of Surgery, University of Colorado Denver, Aurora, Co, USA
| | - Brian Caldwell
- Division of Urology, Department of Surgery, University of Colorado Denver, Aurora, Co, USA
| | - Michael C Rudolph
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado Denver, Aurora, Co, USA
- NORC Metabolic and Cellular Analysis Core Center for Women's Health Research, University of Colorado Denver, Aurora, Co, USA
| | - Anna P Malykhina
- Division of Urology, Department of Surgery, University of Colorado Denver, Aurora, Co, USA.
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Miyazato M, Kadekawa K, Kitta T, Wada N, Shimizu N, de Groat WC, Birder LA, Kanai AJ, Saito S, Yoshimura N. New Frontiers of Basic Science Research in Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2017; 44:491-505. [PMID: 28716328 PMCID: PMC5647782 DOI: 10.1016/j.ucl.2017.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Minoru Miyazato
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan; Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Katsumi Kadekawa
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Takeya Kitta
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Naoki Wada
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Nobutaka Shimizu
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - William C de Groat
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15216, USA
| | - Lori A Birder
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15216, USA
| | - Anthony J Kanai
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15216, USA
| | - Seiichi Saito
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA; Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15216, USA.
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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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Castel-Lacanal E, Gamé X, Clanet M, De Boissezon X, Brassat D, Rischmann P, Marque P. Assessment of a program to encourage the multidisciplinary management of urinary disorders in multiple sclerosis. Neurourol Urodyn 2017; 36:706-709. [DOI: 10.1002/nau.23002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/04/2016] [Indexed: 11/05/2022]
Affiliation(s)
| | - Xavier Gamé
- Département d'urologie; transplantation rénale et andrologie; CHU Toulouse France
| | | | | | | | - Pascal Rischmann
- Département d'urologie; transplantation rénale et andrologie; CHU Toulouse France
| | - Philippe Marque
- Service de médecine physique et réadaptation; CHU Toulouse France
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Some neuropsychiatric and MRI manifestations in patients with multiple sclerosis. MIDDLE EAST CURRENT PSYCHIATRY 2015. [DOI: 10.1097/01.xme.0000458885.02819.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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McMillan MT, Pan XQ, Smith AL, Newman DK, Weiss SR, Ruggieri MR, Malykhina AP. Coronavirus-induced demyelination of neural pathways triggers neurogenic bladder overactivity in a mouse model of multiple sclerosis. Am J Physiol Renal Physiol 2014; 307:F612-22. [PMID: 25007876 DOI: 10.1152/ajprenal.00151.2014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the present study, we aimed to determine whether mice with coronavirus-induced encephalomyelitis (CIE) develop neurogenic bladder dysfunction that is comparable with the neurogenic detrusor overactivity observed in patients with multiple sclerosis. Adult mice (C57BL/6J, 8 wk of age, n = 146) were inoculated with a neurotropic strain of mouse hepatitis virus (A59 strain) and followed for 4 wk. Inoculation with the virus caused a significant neural deficit in mice with an average clinical symptom score of 2.6 ± 0.5 at 2 wk. These changes were accompanied by 25 ± 5% weight loss at 1 and 2 wk postinoculation (P ≤ 0.001 vs. baseline) followed by a recovery phase. Histological analysis of spinal cord sections revealed multifocal sites of demyelinated lesions. Assessment of micturition patterns by filter paper assay determined an increase in the number of small and large urine spots in CIE mice starting from the second week after inoculation. Cystometric recordings in unrestrained awake animals confirmed neurogenic bladder overactivity at 4 wk postinoculation. One week after inoculation with the A59 strain of mouse hepatitis virus, mice became increasingly sensitive to von Frey filament testing with responses enhanced by 45% (n = 8, P ≤ 0.05 vs. baseline at 4 g); however, this initial increase in sensitivity was followed by gradual and significant diminution of abdominal sensitivity to mechanical stimulation by 4 wk postinoculation. Our results provide direct evidence showing that coronavirus-induced demyelination of the central nervous system causes the development of a neurogenic bladder that is comparable with neurogenic detrusor overactivity observed in patients with multiple sclerosis.
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Affiliation(s)
- Matthew T McMillan
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Glenolden, Pennsylvania
| | - Xiao-Qing Pan
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Glenolden, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Glenolden, Pennsylvania
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Glenolden, Pennsylvania
| | - Susan R Weiss
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Michael R Ruggieri
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Anna P Malykhina
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Amarenco G, de Sèze M, Ruffion A, Sheikh Ismael S. Clinical and urodynamic evaluations of urinary disorders in multiple sclerosis. Ann Phys Rehabil Med 2014; 57:277-287. [PMID: 24980885 DOI: 10.1016/j.rehab.2014.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022]
Abstract
Urinary dysfunction is a major clinical problem and a significant cause of disability in multiple sclerosis (MS) patients. Indeed, the bothersome symptom of urinary dysfunction may adversely affect social relationships and activities in MS patients. Since many causes of urinary dysfunction are described, a thorough evaluation including history, clinical examination and evaluation of quality of life is necessary. Generally, diagnosis of urinary disorders is complex with intricated pathophysiologic factors. In these cases, urodynamic investigations are necessary to better understand symptoms pathophysiology and choose the best treatment.
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Affiliation(s)
- G Amarenco
- Sorbonne universités, UPMC université Paris-6, GRC n(o) 01 GREEN (Group of Clinical Research in Neuro-Urology), 4, place Jussieu, 75252 Paris cedex 05, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - M de Sèze
- Clinique Saint-Augustin, 114, avenue d'Ares, 33000 Bordeaux, France
| | - A Ruffion
- Service d'urologie, CNRS, Inra, institut de génomique fonctionnelle de Lyon, centre hospitalier Lyon Sud, hospices civils de Lyon, université de Lyon, 69229 Lyon cedex 02, France
| | - S Sheikh Ismael
- Sorbonne universités, UPMC université Paris-6, GRC n(o) 01 GREEN (Group of Clinical Research in Neuro-Urology), 4, place Jussieu, 75252 Paris cedex 05, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Khatri BO, Foley JF, Fink J, Kramer JF, Cha C, You X, Warth JD, Foulds P. The TRUST (EvaluaTion of Bladder Function in Relapsing-Remitting MUltiple Sclerosis Patients Treated with Natalizumab) Observational Study. Int J MS Care 2014; 16:40-7. [PMID: 24688353 DOI: 10.7224/1537-2073.2013-003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bladder dysfunction is a common symptom of multiple sclerosis (MS). This study was designed to evaluate effects of natalizumab on bladder function in patients with relapsing-remitting MS. METHODS The TRUST (EvaluaTion of Bladder Function in Relapsing-Remitting MUltiple Sclerosis Patients Treated with Natalizumab) study was an open-label, single-arm, two-center study. Natalizumab-naive MS patients with disabling bladder dysfunction and initiating natalizumab were enrolled and followed for 6 months. The primary endpoint was change in the Urogenital Distress Inventory short form (UDI-6) score from baseline. Change in Incontinence Impact Questionnaire short form (IIQ-7) score from baseline was a secondary endpoint. RESULTS Thirty patients were enrolled. Mean baseline characteristics were age 49.9 years, Expanded Disability Status Scale score 4.6, number of relapses in previous year 2.4, UDI-6 score 10.4, and IIQ-7 score 12.3. Mean changes in UDI-6 and IIQ-7 scores were significantly improved from baseline beginning at week 4 and up to week 24; mean improvements at 24 weeks were 4.4 (P < .0001) and 4.9 (P = .0005) points, respectively. At week 24, 85.7% and 78.6% of patients demonstrated improvements from baseline in UDI-6 and IIQ-7 scores, respectively. CONCLUSIONS Incontinence-related quality of life as measured by UDI-6 and IIQ-7 scores improved significantly during natalizumab treatment.
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Affiliation(s)
- Bhupendra O Khatri
- Center for Neurological Disorders and the Regional Multiple Sclerosis Center, Wheaton Franciscan Health Care, Milwaukee, WI, USA (BOK, JFK); Rocky Mountain Multiple Sclerosis Center, Salt Lake City, UT, USA (JFF); Aurora St. Luke's Medical Center, Milwaukee, WI, USA (JF); Elan Pharmaceuticals, Inc, San Francisco, CA, USA (CC); and Biogen Idec Inc, Cambridge, MA, USA (XY, JDW, PF). Dr. Warth is now with Genzyme Corporation, Cambridge, MA, USA
| | - John F Foley
- Center for Neurological Disorders and the Regional Multiple Sclerosis Center, Wheaton Franciscan Health Care, Milwaukee, WI, USA (BOK, JFK); Rocky Mountain Multiple Sclerosis Center, Salt Lake City, UT, USA (JFF); Aurora St. Luke's Medical Center, Milwaukee, WI, USA (JF); Elan Pharmaceuticals, Inc, San Francisco, CA, USA (CC); and Biogen Idec Inc, Cambridge, MA, USA (XY, JDW, PF). Dr. Warth is now with Genzyme Corporation, Cambridge, MA, USA
| | - Jennifer Fink
- Center for Neurological Disorders and the Regional Multiple Sclerosis Center, Wheaton Franciscan Health Care, Milwaukee, WI, USA (BOK, JFK); Rocky Mountain Multiple Sclerosis Center, Salt Lake City, UT, USA (JFF); Aurora St. Luke's Medical Center, Milwaukee, WI, USA (JF); Elan Pharmaceuticals, Inc, San Francisco, CA, USA (CC); and Biogen Idec Inc, Cambridge, MA, USA (XY, JDW, PF). Dr. Warth is now with Genzyme Corporation, Cambridge, MA, USA
| | - John F Kramer
- Center for Neurological Disorders and the Regional Multiple Sclerosis Center, Wheaton Franciscan Health Care, Milwaukee, WI, USA (BOK, JFK); Rocky Mountain Multiple Sclerosis Center, Salt Lake City, UT, USA (JFF); Aurora St. Luke's Medical Center, Milwaukee, WI, USA (JF); Elan Pharmaceuticals, Inc, San Francisco, CA, USA (CC); and Biogen Idec Inc, Cambridge, MA, USA (XY, JDW, PF). Dr. Warth is now with Genzyme Corporation, Cambridge, MA, USA
| | - Choon Cha
- Center for Neurological Disorders and the Regional Multiple Sclerosis Center, Wheaton Franciscan Health Care, Milwaukee, WI, USA (BOK, JFK); Rocky Mountain Multiple Sclerosis Center, Salt Lake City, UT, USA (JFF); Aurora St. Luke's Medical Center, Milwaukee, WI, USA (JF); Elan Pharmaceuticals, Inc, San Francisco, CA, USA (CC); and Biogen Idec Inc, Cambridge, MA, USA (XY, JDW, PF). Dr. Warth is now with Genzyme Corporation, Cambridge, MA, USA
| | - Xiaojun You
- Center for Neurological Disorders and the Regional Multiple Sclerosis Center, Wheaton Franciscan Health Care, Milwaukee, WI, USA (BOK, JFK); Rocky Mountain Multiple Sclerosis Center, Salt Lake City, UT, USA (JFF); Aurora St. Luke's Medical Center, Milwaukee, WI, USA (JF); Elan Pharmaceuticals, Inc, San Francisco, CA, USA (CC); and Biogen Idec Inc, Cambridge, MA, USA (XY, JDW, PF). Dr. Warth is now with Genzyme Corporation, Cambridge, MA, USA
| | - John D Warth
- Center for Neurological Disorders and the Regional Multiple Sclerosis Center, Wheaton Franciscan Health Care, Milwaukee, WI, USA (BOK, JFK); Rocky Mountain Multiple Sclerosis Center, Salt Lake City, UT, USA (JFF); Aurora St. Luke's Medical Center, Milwaukee, WI, USA (JF); Elan Pharmaceuticals, Inc, San Francisco, CA, USA (CC); and Biogen Idec Inc, Cambridge, MA, USA (XY, JDW, PF). Dr. Warth is now with Genzyme Corporation, Cambridge, MA, USA
| | - Pam Foulds
- Center for Neurological Disorders and the Regional Multiple Sclerosis Center, Wheaton Franciscan Health Care, Milwaukee, WI, USA (BOK, JFK); Rocky Mountain Multiple Sclerosis Center, Salt Lake City, UT, USA (JFF); Aurora St. Luke's Medical Center, Milwaukee, WI, USA (JF); Elan Pharmaceuticals, Inc, San Francisco, CA, USA (CC); and Biogen Idec Inc, Cambridge, MA, USA (XY, JDW, PF). Dr. Warth is now with Genzyme Corporation, Cambridge, MA, USA
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Nikfallah A, Rezaali S, Mohammadi N, Abrishamkar M, Rezaei E, Sahraian MA, Pakpour AH, Yekaninejad MS. Translation, Cultural Adaptation and Validation of the Qualiveen-30 Questionnaire in Persian for Patients with Spinal Cord Injury and Multiple Sclerosis. Low Urin Tract Symptoms 2014; 7:42-9. [PMID: 26663651 DOI: 10.1111/luts.12051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to cross-culturally translate the Qualiveen-30 into Persian and validate it in Iranian patients with spinal cord injury (SCI) and multiple sclerosis (MS). METHODS This was a cross-sectional prospective validation study. The translation and cross-cultural adaptation of the original questionnaire was performed in accordance with published guidelines. A total of 154 patients with SCI or MS who suffered from lower urinary symptoms for at least 6 months were asked to complete the questionnaire in the first visit to the clinic and after 3 weeks. To assess reliability, the internal consistency was assessed by Cronbach's alpha coefficient, and validity was assessed using convergent and discriminant validities. RESULTS The Cronbach's alpha coefficients for the Qualiveen-30 at two assessments ranged from 0.82 to 0.95, indicating a good internal consistency for the questionnaire. There were high amounts of test-retest reliability for the Qualiveen questionnaire and each of its domains (ICC > 0.90). Also, Qualiveen and its domains had a moderate to high correlation with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) (0.36 < r < 0.57) and SF-12 MCS (-0.51 < r < -0.11) and SF-12 PCS (-0.29 < r < -0.19), indicating good convergent validity. Comparison of Qualiveen in groups of income, education and manner of voiding revealed the high discriminative power of this instrument. The hypothesized four factor structure was approved using confirmatory factor analysis (CFA). CONCLUSIONS In general, the Persian version of Qualiveen-30 performed is a reliable and valid measure for the evaluation of the quality of life related to lower urinary symptoms in patients with SCI or MS.
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Affiliation(s)
- Abolghasem Nikfallah
- Department of Urology, Brain and Spinal Injury Research Center (BASIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Rezaali
- MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Nooredin Mohammadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Centre for Nursing Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Abrishamkar
- Department of Urology, Brain and Spinal Injury Research Center (BASIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Rezaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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12
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Voiding Dysfunction in Multiple Sclerosis: Disease Review and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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De Ridder D, Van Der Aa F, Debruyne J, D’hooghe MB, Dubois B, Guillaume D, Heerings M, Ilsbroukx S, Medaer R, Nagels G, Seeldrayers P, Van Landegem W, Willekens B, Zicot AF. Consensus guidelines on the neurologist's role in the management of neurogenic lower urinary tract dysfunction in multiple sclerosis. Clin Neurol Neurosurg 2013; 115:2033-40. [DOI: 10.1016/j.clineuro.2013.06.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/11/2013] [Accepted: 06/24/2013] [Indexed: 11/25/2022]
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14
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Castel-Lacanal E, Gamé X, Clanet M, Gasq D, De Boissezon X, Guillotreau J, Bourg V, Viala F, Rischmann P, Marque P. Urinary complications and risk factors in symptomatic multiple sclerosis patients. Study of a cohort of 328 patients. Neurourol Urodyn 2013; 34:32-6. [DOI: 10.1002/nau.22495] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/20/2013] [Indexed: 11/07/2022]
Affiliation(s)
| | - Xavier Gamé
- Département d'urologie; transplantation rénale et andrologie; CHU; Toulouse France
| | | | - David Gasq
- Service de médecine physique et réadaptation; CHU; Toulouse France
| | | | - Julien Guillotreau
- Département d'urologie; transplantation rénale et andrologie; CHU; Toulouse France
| | - Véronique Bourg
- Service de médecine physique et réadaptation; CHU; Toulouse France
| | | | - Pascal Rischmann
- Département d'urologie; transplantation rénale et andrologie; CHU; Toulouse France
| | - Philippe Marque
- Service de médecine physique et réadaptation; CHU; Toulouse France
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Çetinel B, Tarcan T, Demirkesen O, Özyurt C, Şen İ, Erdoğan S, Siva A. Management of lower urinary tract dysfunction in multiple sclerosis: a systematic review and Turkish consensus report. Neurourol Urodyn 2013; 32:1047-57. [PMID: 23757108 DOI: 10.1002/nau.22374] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 12/17/2012] [Indexed: 01/05/2023]
Abstract
AIMS Since lower urinary tract dysfunction (LUTD) related to multiple sclerosis (MS) has a different behavior pattern than other types of neurogenic voiding dysfunction, we aimed to prepare a national consensus report for the management of LUTD due to multiple sclerosis in light of available literature. METHODS A search of available databases yielded an evidence base of 125 articles after the application of inclusion/exclusion criteria. When sufficient evidence existed, recommendations A (high), B (moderate), or C (low) were made according to the strength of evidence; recommendation D was provided when insufficient evidence existed. RESULTS Available data did not support the use of invasive urodynamics in the initial evaluation of patients with MS and LUTD. Clinical studies on the safety and efficacy of antimuscarinics and alpha-blockers in these patients were scarce and low quality. Desmopressin could be used in MS-related overactive bladder symptoms owing to its short-term effects as an adjunctive treatment. Intravesical botulinum toxin type A treatment in patients with MS and detrusor overactivity was recommended in cases of medical treatment failure or severe side effects due to antimuscarinics. Pelvic floor rehabilitation together with neuromuscular electrical stimulation was also recommended as it increased symptomatic treatment success. This systematic review was not able to find any evidence-based cut off post-void residual value for the recommendation to start clean intermittent catheterization in MS-related LUTD. CONCLUSIONS Patients with MS and LUTD could be best managed through the use of this consensus report.
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Affiliation(s)
- Bülent Çetinel
- Cerrahpaşa Faculty of Medicine, Department of Urology, İstanbul University, İstanbul, Turkey.
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16
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Amarenco G, Chartier-Kastler E, Denys P, Jean JL, de Sèze M, Lubetzski C. First-line urological evaluation in multiple sclerosis: validation of a specific decision-making algorithm. Mult Scler 2013; 19:1931-7. [PMID: 23698129 DOI: 10.1177/1352458513489758] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Urinary disorders that lead to urological complications are frequent in multiple sclerosis, resulting in diminished quality of life. Urinary management guidelines are scarce and targeted to neuro-urology specialists. OBJECTIVE This study aimed to construct and validate an algorithm dedicated to neurologists and general practitioners to facilitate first-line evaluation and treatment of urinary disorders associated with multiple sclerosis. METHODS 49 items concerning urological symptom evaluation and therapeutic strategies were derived from literature analysis and evaluated by an expert panel. The Delphi method established consensus between the experts and allowed development of the First-Line Urological Evaluation in Multiple Sclerosis (FLUE-MS) algorithm. Two questions from the Urinary Bothersome Questionnaire in Multiple Sclerosis were included and their validation to verify comprehensiveness and acceptability was also conducted. RESULTS Three rounds of expert review obtained consensus of all 49 items and allowed finalisation of the algorithm. Comprehension and acceptability of two Urinary Bothersome Questionnaire in Multiple Sclerosis questions were verified (mean comprehensiveness score: 1.99/2 [99.7% total comprehensiveness], mean acceptability score: 1.99/2 [99.1% complete acceptability]). CONCLUSION The FLUE-MS algorithm was designed for neurologists and general practitioners, enabling identification of 'red flags', timely patient referral to specialist neuro-urology units, and appropriate first-line therapy.
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Affiliation(s)
- Gérard Amarenco
- Service de Neuro-Urologie et d'Explorations Périnéales, Hôpital TENON, APHP, France, GREEN UPMC, GRC 01 UPMC
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17
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Castel-Lacanal E, Gamé X, De Boissezon X, Guillotreau J, Braley-Berthoumieux E, Terracol C, Gasq D, Labrunee M, Viala F, Rischmann P, Clanet M, Marque P. Impact of intermittent catheterization on the quality of life of multiple sclerosis patients. World J Urol 2013; 31:1445-50. [DOI: 10.1007/s00345-012-1017-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/20/2012] [Indexed: 11/28/2022] Open
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18
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Dillon BE, Seideman CA, Lee D, Greenberg B, Frohman EM, Lemack GE. A surprisingly low prevalence of demonstrable stress urinary incontinence and pelvic organ prolapse in women with multiple sclerosis followed at a tertiary neurogenic bladder clinic. J Urol 2012; 189:976-9. [PMID: 23022010 DOI: 10.1016/j.juro.2012.09.101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE We report the prevalence of stress urinary incontinence and pelvic organ prolapse in patients with multiple sclerosis referred to a tertiary care neurogenic bladder clinic. MATERIALS AND METHODS We queried an institutional review board approved neurogenic bladder database for urodynamic and demographic data on patients with multiple sclerosis followed for lower urinary tract symptoms in a 12-year period. Demographic information included multiple sclerosis classification, age at initial visit, body mass index, parity and pelvic examination findings. Prolapse was defined as stage 2 prolapse or greater. Stress urinary incontinence was defined as urodynamic stress incontinence and/or incontinence on a supine stress test. RESULTS Included in analysis were 280 women with a mean age of 50 years and a mean 13-year history of multiple sclerosis. Relapse remitting multiple sclerosis was noted in 40% of patients, while 45 (16%) had stress urinary incontinence. Women with stress urinary incontinence had a higher average maximum urine flow (14 vs 9 ml per second, p <0.003), higher voided volume (272 vs 194 cc, p = 0.018) and higher body mass index (30 vs 25 kg/m(2), p <0.005). Overall, 23 women (9%) had pelvic organ prolapse, including 2 (9%) with posterior prolapse only, 8 (35%) with anterior prolapse only and 13 (56%) with posterior and anterior prolapse. There was no difference in age, body mass index or multiple sclerosis subtype between women with vs without pelvic organ prolapse. CONCLUSIONS The 14% prevalence of demonstrable stress urinary incontinence and 9% rate of pelvic organ prolapse are markedly lower than published historical data on an age matched cohort without multiple sclerosis. The surprisingly low prevalence of stress urinary incontinence and pelvic organ prolapse in women with multiple sclerosis may be attributable to decreased activity, a neurogenically enhanced vesicourethral unit or other functional or anatomical etiologies.
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Affiliation(s)
- Benjamin E Dillon
- Department of Urology, University of Texas Southwestern, Dallas, Texas 75390-9110, USA.
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19
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Patti F, Ventimiglia B, Failla G, Genazzani AA, Reggio A. Micturition disorders in multiple sclerosis patients: neurological, neurourodynamic and magnetic resonance findings. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1997.tb00345.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Fowler CJ, Dalton C, Panicker JN. Review of neurologic diseases for the urologist. Urol Clin North Am 2010; 37:517-26. [PMID: 20955903 DOI: 10.1016/j.ucl.2010.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This article reviews the neurologic conditions associated with a high prevalence of bladder dysfunction and about which significant advances in understanding have occurred in recent years. The importance of the frontal lobes for bladder control has been confirmed through functional brain imaging, and recent findings in the elderly with incontinence suggest the problem may result from disconnection of important frontal areas caused by white matter disease. The very different urologic profile of the two sometimes-confused conditions, multiple system atrophy and Parkinson's disease, is clarified. The advances in treatments for multiple sclerosis in recent years have been remarkable and are briefly described.
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Affiliation(s)
- Clare J Fowler
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UCLH, Box 71, Queen Square, London WC1N 3BG, UK.
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21
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Bronner G, Elran E, Golomb J, Korczyn AD. Female sexuality in multiple sclerosis: the multidimensional nature of the problem and the intervention. Acta Neurol Scand 2010; 121:289-301. [PMID: 20070276 DOI: 10.1111/j.1600-0404.2009.01314.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Female sexual functioning is a complex process involving physiological, psychosocial and interpersonal factors. Sexual dysfunction (SD) is frequent (40-74%) among women with multiple sclerosis (MS), reflecting neurological dysfunction, psychological factors, depression, side effects of medications and physical manifestations of the disease, such as fatigue and muscle weakness. A conceptual model for sexual problems in MS characterizes three levels. Primary SD includes impaired libido, lubrication, and orgasm. Secondary SD is composed of limiting sexual expressions due to physical manifestations. Tertiary SD results from psychological, emotional, social, and cultural aspects. Sexual problems cause distress and may affect the family bond. Practical suggestions on initiation of discussion of sexual issues for MS patients are included in this review. Assessment and treatment of sexual problems should combine medical and psychosexual approaches and begin early after MS diagnosis. Intervention can be done by recognizing sexual needs, educating and providing information, by letting patients express their difficulties and referring them to specialists and other information resources.
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Affiliation(s)
- Gila Bronner
- Sexual Medicine Center, Department of Urology, Sheba Medical Center, Tel Hashomer, Israel.
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Nakipoglu G, Kaya A, Orhan G, Tezen O, Tunc H, Ozgirgin N, Ak F. Urinary dysfunction in multiple sclerosis. J Clin Neurosci 2009; 16:1321-4. [DOI: 10.1016/j.jocn.2008.12.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Revised: 10/23/2008] [Accepted: 12/30/2008] [Indexed: 10/20/2022]
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Abstract
Multiple sclerosis (MS) is a relatively common disease of young adults. Patients with MS can have a wide range of symptoms and may develop significant disability. The cause of MS is unknown, but immunological mechanisms are important. In MS, the pathological features include prominent demyelination and inflammation, but there is also evidence of neurodegeneration. Bladder symptoms are common in MS. The bladder is under neural control, and bladder disturbance is usually attributed to demyelination or loss of axons from the neural pathways, particularly those in the spinal cord, that control the bladder. However, as with other symptoms in MS, the presence of bladder disturbance does not always correlate well with MRI lesions. We speculate that other possible causes of bladder dysfunction in MS might include the effects of circulating toxic factors. Urgency of micturition is prominent in MS, and better understanding of the receptors involved in bladder sensation suggests possible treatment strategies through inhibiting these receptors.
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Affiliation(s)
- Pamela A McCombe
- Center for Clinical Research, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
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24
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Fletcher SG, Lemack GE. Evaluation and management of neurogenic vesicourethral dysfunction in multiple sclerosis. CURRENT BLADDER DYSFUNCTION REPORTS 2009. [DOI: 10.1007/s11884-009-0011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Castel-Lacanal E, Gamé X, De Boissezon X, Guillotreau J, Bourg V, Clanet M, Roques CF, Marque P. Observance et impact sur la qualité de vie du cathétérisme intermittent chez les patients atteints de sclérose en plaques. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s11608-009-0225-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Motta R, de Carvalho MLL. Management of bladder dysfunction in multiple sclerosis patients: the nurse's point of view. Neurol Sci 2008; 29 Suppl 4:S356-9. [PMID: 19089676 DOI: 10.1007/s10072-008-1043-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It is estimated that as many as 90% of people with multiple sclerosis (MS) experience some type of urinary disturbance over the course of the disease. The importance of an interdisciplinary approach is crucial in the management of a symptom requiring the involvement of different professionals, with specific expertise in evaluation and treatment. The MS nurse is perhaps the professional most likely to be in a position to initiate the process of identifying urological dysfunction. The evaluation can be started by reviewing symptoms recorded in the patient's medical records over time. Along with the use of a urinary diary and a check of the patient's post-void residual at the time of each visit, this can aid the MS nurse in recognising which urinary dysfunction could be affecting the patient. The MS nurse can also have an important role in teaching the patient behaviour strategies that aid in both evaluating and treating urinary dysfunction. Finally, the MS nurse can be the primary instructor of techniques related to intermittent catheterisation procedures. A new topic highlighting the ever-developing role of the MS nurse is in the field of rehabilitation. This article highlights urinary symptoms experienced by people with MS and strategies used for treating them. The role of the MS nurse in managing urinary dysfunction is also discussed.
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Affiliation(s)
- Roberta Motta
- Italian Multiple Sclerosis Society, Via Operai 30, 16149, Genoa, Italy.
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27
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D’Ancona CAL, Tamanini JT, Botega N, Lavoura N, Ferreira R, Leitão V, Lopes MHBM. Quality of life of neurogenic patients: translation and validation of the Portuguese version of Qualiveen. Int Urol Nephrol 2008; 41:29-33. [DOI: 10.1007/s11255-008-9402-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 05/16/2008] [Indexed: 11/24/2022]
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de Sèze M, Ruffion A, Denys P, Joseph PA, Perrouin-Verbe B. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler 2007; 13:915-28. [PMID: 17881401 DOI: 10.1177/1352458506075651] [Citation(s) in RCA: 277] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vesicourethral dysfunction is very frequent in multiple sclerosis (MS) and has functional consequences for patients' quality of life and also an organic impact following complications of the neurogenic bladder on the upper urinary tract. While the functional impact and its management are well documented in the literature, the organic impact remains underestimated and there are no consensual practical guidelines for the screening and prevention of MS neurogenic bladder complications. The aim of this review of the literature, focused on identifying the risk factors of urinary tract complications in MS, is to put forward well informed considerations to help in the definition of practical guidelines for the follow-up of the neurogenic bladder in MS in order to improve its prevention and patient management. Four main risk factors have been identified for upper urinary tract damage: the duration of MS, the presence of an indwelling catheter, high-amplitude neurogenic detrusor contractions and permanent high detrusor pressure. Detrusor-sphincter dyssynergia, age over 50 and male sex may form three additional risk factors. Recommendations for long-term urological follow-up, taking into account these specific risks are constructed according to the procedures recommended by the French Health Authorities.
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Affiliation(s)
- Marianne de Sèze
- Unité d'Evaluation et de Traitement du Handicap Urinaire, Service de Médecine Physique et de Réadaptation, CHU Pellegrin, Equipe de Recherche Handicap et Système Nerveux, Bordeaux Cedex, France.
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30
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Kalsi V, Fowler CJ. Therapy Insight: bladder dysfunction associated with multiple sclerosis. ACTA ACUST UNITED AC 2006; 2:492-501. [PMID: 16474623 DOI: 10.1038/ncpuro0323] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Accepted: 08/24/2005] [Indexed: 11/09/2022]
Abstract
Bladder dysfunction is a common problem for patients with multiple sclerosis. The severity of symptoms often correlate with the degree of spinal cord involvement and, hence, the patient's general level of disability. The emphasis of management is now mainly medical and is increasingly offered by nonurologists. Treatments can be highly effective, relieving patients of what are otherwise very troublesome symptoms that would compound their neurological disability. This article gives an overview of the neural control of the bladder, followed by an explanation of the pathophysiology of detrusor overactivity secondary to neurological disease. A review of methods available for treating bladder dysfunction in multiple sclerosis then follows. The treatment options for this disorder are largely medical and include established first-line measures such as anticholinergics, clean intermittent self-catheterization and the use of desmopressin, as well as potential second-line agents, such as cannabinoids, intravesical vanilloids and intradetrusor botulinum neurotoxin type A. The diminishing role of surgical intervention is also discussed.
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Affiliation(s)
- Vinay Kalsi
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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31
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Denys P, Corcos J, Everaert K, Chartier-Kastler E, Fowler C, Kalsi V, Nitti V, Schulte-Baukloh H, Schurch B. Improving the global management of the neurogenic bladder patient: part I. The complexity of patients. Curr Med Res Opin 2006; 22:359-65. [PMID: 16466608 DOI: 10.1185/030079906x89702] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The management of urinary incontinence in patients with neurological disease is complex. Physicians face a multitude of challenges related to progression of the primary condition, the presence of a diversity of other related and unrelated symptoms, the safety, efficacy and tolerability issues associated with multiple therapies being required and the changing need for collaboration with other specialities. SCOPE Current guidelines produced by the urological communities, as well as the disease-focused organizations, aim to standardize care in their specific group of patients. A passive approach to implementation, however, means that guidelines produced are all too frequently not readily available to, read by or followed by the wider audience. In addition, each speciality has its own guidelines and a different view of the primary focus of care in neurological patients, which may lead to variations in recommendations and, subsequently, in clinical practice. A review of current urological and disease specific guidelines was made to evaluate differences between the published guidance between the specialities and within urology itself. CONCLUSIONS Although availability of effective therapies remains a cornerstone of neurogenic bladder treatment, consideration must also be given to the non-pharmacological and surgical issues related to the global management of this population. Improved cross-speciality interactions and development of patient-specific treatment and follow-up plans, which are in keeping with the current guidelines of each speciality involved, may serve to enhance physicians' understanding of the importance of effective urinary incontinence treatment as well as the overall management of the patient.
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Affiliation(s)
- Pierre Denys
- Affiliation Hôpital Raymond Poincaré, Garches, France.
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Ukkonen M, Elovaara I, Dastidar P, Tammela TLJ. Urodynamic findings in primary progressive multiple sclerosis are associated with increased volumes of plaques and atrophy in the central nervous system. Acta Neurol Scand 2004; 109:100-5. [PMID: 14705971 DOI: 10.1034/j.1600-0404.2003.00184.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Voiding dysfunction is more frequent in primary progressive multiple sclerosis (PPMS) than in other subtypes of MS. We investigated whether lower urinary tract disorders are reflected in the extent of changes in brain and spinal cord detected by magnetic resonance imaging (MRI). METHODS Micturition symptoms and specific urodynamic findings in 24 patients with PPMS were related to MRI abnormalities as analysed by segmentation and volumetric analysis. RESULTS Urgency and urge incontinence were the most frequent urinary symptoms (83 and 75 %), while detrusor sphincter dyssynergia (DSD) (71%), detrusor hyperreflexia (58%) and obstruction (58%) were the most common micturition dysfunctions. Comparison between patients with detrusor hyperreflexia and those with normal bladder function revealed higher volumes of T2-weighted plaques in the brains of former (P = 0.01). In patients with hypotonic bladder the total brain volume was smaller (P = 0.02) and the number of thoracic plaques in T2-weighted images higher (P = 0.02) compared to patients with normal bladder function. Furthermore, DSD was associated with a higher volume of T2-weighted plaques in the brain (P = 0.02). CONCLUSIONS Voiding dysfunction in PPMS is associated with increasing brain and spinal cord abnormalities. Urodynamic investigation is, however, needed for specific definition of micturition disturbances and should be made before therapeutic decisions.
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Affiliation(s)
- M Ukkonen
- Neuroimmunology Unit, Department of Neurology, Tampere University Hospital, Tampere, Finland
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Abstract
Autonomic dysfunction causes significant disability in patients with multiple sclerosis (MS). Abnormalities of bladder, bowel and sexual function have been well documented in previous studies but cardiovascular and sudomotor autonomic changes have been less frequently reported. The present study has documented autonomic symptoms and results of cardiovascular and sudomotor autonomic function tests in 63 MS patients and correlated these changes with the clinical features of MS.Autonomic symptoms were common in MS patients, the most common being disorders of micturition, impotence, sudomotor and gastrointestinal disturbances, which were associated with increased MS severity. There was no significant association between autonomic symptoms and abnormalities of autonomic investigations. Abnormalities of one or more autonomic function tests, not including those of bladder, gastrointestinal or sexual dysfunction, were present in more than one half of the MS patients. Autonomic dysfunction, defined as abnormalities in two or more tests, was found in 18% of patients and was associated with increased MS severity. Postural hypotension was very uncommon. Parasympathetic cardiovascular autonomic abnormalities occurred in 16% of patients and were associated with increased MS severity. Sympathetic cardiovascular abnormalities were present in 13% of patients and showed no significant association with MS severity. The sympathetic skin response(SSR) was abnormal in nearly one half of the patients and also showed no significant association with MS severity. There was a variable and heterogenous pattern of autonomic test abnormalities found in the MS patients, which were of minor clinical significance except for postural hypotension. Cardiovascular and sudomotor autonomic abnormalities in MS patients are likely to be due to plaques distributed throughout the brainstem and spinal cord affecting anatomically widespread autonomic regulatory areas and their connections.
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Affiliation(s)
- A J McDougall
- Department of Neurophysiology, Liverpool Hospital, University of New South Wales, Liverpool NSW 2170, Australia
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Murray TJ. Thomas John (Jock) Murray, OC, MD, FRCP(C), MACP, LLD(HON), DSc(Hon), FRCP(Lon): a conversation with the editor. Interview by William Clifford Roberts. Proc AMIA Symp 2003; 16:469-85. [PMID: 16278764 PMCID: PMC1214566 DOI: 10.1080/08998280.2003.11927944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Araki I, Matsui M, Ozawa K, Takeda M, Kuno S. Relationship of bladder dysfunction to lesion site in multiple sclerosis. J Urol 2003; 169:1384-7. [PMID: 12629367 DOI: 10.1097/01.ju.0000049644.27713.c8] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We investigated the relationship of voiding dysfunction type and the lesion site in patients with multiple sclerosis. MATERIALS AND METHODS Voiding dysfunction was evaluated in 32 patients with multiple sclerosis using the International Prostate Symptom Score and urodynamic tests. Lesion sites were determined by combined neurological examination and magnetic resonance imaging findings. RESULTS Compared with reports from Western countries the ratio of emptying-to-filling symptoms was high in Japan. Of urinary symptoms only filling correlated with disability status and disease duration. Urinary symptoms were not related to lesion sites. Urodynamic evaluation revealed detrusor hyperreflexia in 14 of 32 patients, hyporeflexia or areflexia in 12, detrusor hyperreflexia with impaired contractile function in 4, a low compliance bladder in 1 and normal function in 1. Of 14 patients with hyperreflexia 13 had overactive sphincter concurrently. Incompetent sphincter was identified in 2 patients who had detrusor hyperreflexia with impaired contractility and in 1 with a low compliance bladder. A significant correlation was noted for a pontine lesion and detrusor hyporeflexia, and for a cervical cord lesion and detrusor-sphincter dyssynergia. CONCLUSIONS Detrusor hyporeflexia and detrusor-sphincter dyssynergia are indicative of a pontine and cervical spinal cord lesion, respectively. Thus, the lesion site in the central nervous system may be a major determinant of the type of bladder and urethral sphincter dysfunction. The high prevalence of emptying symptoms in Japanese patients may reflect the prevalence of detrusor hyporeflexia and detrusor-sphincter dyssynergia.
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Affiliation(s)
- Isao Araki
- Department of Urology, Utano National Hospital, Kyoto, Japan
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DasGupta R, Fowler CJ. Sexual and urological dysfunction in multiple sclerosis: better understanding and improved therapies. Curr Opin Neurol 2002; 15:271-8. [PMID: 12045724 DOI: 10.1097/00019052-200206000-00008] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The fundamental strategy in treating multiple sclerosis patients with unstable bladders involves a combination of suppressing urgency and ensuring effective urinary drainage. Anti-cholinergics remain the first-line treatment, but alternative therapies are undergoing clinical trials. With a range of new pro-erectile oral medications available, interest has grown in treatment of multiple sclerosis-related erectile failure. Female sexual dysfunction is also now gaining some attention, with new classification criteria and methods for assessing and treating these patients.
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Affiliation(s)
- Ranan DasGupta
- Department of UroNeurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
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Abstract
AUR is a commonly seen genitourinary emergency. It has many etiologies, including obstructive, neurogenic, pharmacologic, and extraurinary causes. Treatment is immediate bladder decompression by transurethral catheterization and treatment of the provoking etiology. Urinary incontinence is less commonly seen as a presenting complaint in the ED. For the emergency physician, the key lies in recognizing its underlying cause. Neurologic and pharmacologic causes need to be considered in all patients. Urinary incontinence that is not caused by a neurologic emergency can be referred for further outpatient evaluation.
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Affiliation(s)
- L A Curtis
- Department of Emergency Medicine, Georgetown University Medical Center, Washington, DC, USA
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Bashir K, Cai CY, Moore TA, Whitaker JN, Hadley MN. Surgery for Cervical Spinal Cord Compression in Patients with Multiple Sclerosis. Neurosurgery 2000. [DOI: 10.1227/00006123-200009000-00022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bashir K, Cai CY, Moore TA, Whitaker JN, Hadley MN. Surgery for cervical spinal cord compression in patients with multiple sclerosis. Neurosurgery 2000; 47:637-42; discussion 642-3. [PMID: 10981751 DOI: 10.1097/00006123-200009000-00022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The goal of this study was to investigate the clinical and paraclinical features, treatment, and outcomes of patients with multiple sclerosis (MS) and coexisting spinal cord compression secondary to either cervical spondylosis or cervical disc disease. Patients with MS commonly experience neurological disabilities that present as myelopathy associated with bladder dysfunction. For some patients with MS, however, this neurological deterioration may result from coexisting spinal cord compression attributable to either spondylosis or a herniated disc. Overlapping symptoms of the two conditions do not allow clear clinical determination of the underlying cause of worsening. METHODS Patients with MS who underwent cervical decompression surgery were selected. Medical records were retrospectively reviewed, to collect data on their pre- and postoperative clinical courses. RESULTS Nine women and five men with definite MS were selected for cervical decompression surgery to treat neurological deterioration considered to be at least partially attributable to spinal cord compression. The most common symptoms were progressive myelopathy (n = 13), neck pain (n = 11), and cervical radiculopathy (n = 10). Bladder dysfunction was notably absent among these patients with MS with moderate disabilities. Surgical intervention was frequently delayed because the neurological deterioration was initially thought to be attributable to MS. The majority of patients experienced either improvement or stabilization of their preoperative symptoms in the immediate postoperative period; three subjects (21%) maintained this improvement after a mean follow-up period of 3.8 years. No MS relapses, permanent neurological worsening, or serious complications resulting from surgery or general anesthesia were noted. CONCLUSION Carefully selected patients with MS and cervical spinal cord compression secondary to either spondylosis or disc disease may benefit from surgical decompression, with minimal associated morbidity. Clinical features (especially neck pain and cervical radiculopathy) and magnetic resonance imaging may assist clinicians in differentiating between the two conditions and may guide appropriate treatment without undue delay.
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Affiliation(s)
- K Bashir
- Department of Neurology, University of Alabama at Birmingham, and Neurology and Research Services of the Birmingham Veterans Medical Center, USA
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Zorzon M, Zivadinov R, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Morassi P, Iona LG, Cazzato G. Sexual dysfunction in multiple sclerosis: a case-control study. I. Frequency and comparison of groups. Mult Scler 1999; 5:418-27. [PMID: 10618699 DOI: 10.1177/135245859900500i609] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sexual dysfunction is a very important but often overlooked symptom of multiple sclerosis. To investigate the type and frequency of symptoms of sexual dysfunction in patients suffering from multiple sclerosis, we performed a case-control study comparing 108 unselected patients with definite multiple sclerosis, 97 patients with chronic disease and 110 healthy individuals with regard to sexual function, sphincteric function, physical disorders impeding sexual activity and the impact of sexual dysfunction on social life. Information has been collected from a face-to-face structured interview performed by a doctor of the same gender as the patient. The disability, the cognitive performances, the psychiatric conditions and the psychological profile of patients and controls have been assessed. Sexual dysfunction was present in 73.1% of cases, in 39.2% of chronic disease controls and in 12.7% of healthy controls (P<0.0001). Male cases reported symptoms of sexual dysfunction more frequently than female cases (P<0.002). Symptoms of sexual dysfunction more commonly reported in patients with multiple sclerosis were anorgasmia or hyporgasmia (37.1%), decreased vaginal lubrication (35.7%) and reduced libido (31.4%) in women, and impotence or erectile dysfunction (63.2%), ejaculatory dysfunction and/or orgasmic dysfunction (50%) and reduced libido (39.5%) in men. Seventy-five per cent of cases, 51.5% of chronic disease controls and 28.2% of healthy controls (P<0.0001) experienced symptoms of sphincteric dysfunction. In conclusion, a substantial part of our sample of patients with multiple sclerosis reported symptoms of sexual and sphincteric dysfunction. Both sexual and sphincteric dysfunction were significantly more common in patients with multiple sclerosis than in either control group. Our findings suggest that a peculiar damage of the structures involved in sexual function is responsible for the dysfunction in patients with multiple sclerosis, but the highly significant lower frequency of symptoms of depression and anxiety in healthy controls may also imply a possible causative role of psychological factors.
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Affiliation(s)
- M Zorzon
- Clinical Neurology, University of Trieste, Trieste, Italy
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Giannantoni A, Scivoletto G, Di Stasi SM, Grasso MG, Finazzi Agrò E, Collura G, Vespasiani G. Lower urinary tract dysfunction and disability status in patients with multiple sclerosis. Arch Phys Med Rehabil 1999; 80:437-41. [PMID: 10206607 DOI: 10.1016/s0003-9993(99)90282-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the correlation between neurologic and urologic status in patients with multiple sclerosis (MS). MATERIALS AND METHODS Between January 1993 and December 1995, 116 patients with MS symptoms were fully assessed neurologically and urologically with urodynamic studies. RESULTS Urodynamic abnormalities were detected in 104 patients (89.6%). Several significant relationships between urinary tract findings and neurologic dysfunction were: (1) the relation between voiding disorder as the presenting symptom of the disease and a higher severity of bladder dysfunction; (2) the relation between reduced bladder sensation and longer duration of voiding disorders, lower detrusor uninhibited contractions threshold, and lower bladder capacity; and (3) the relation between voiding disorders and cerebellar system score. Finally, a significant inverse relationship was found between detrusor hypocontractility and neurologic status (from the Expanded Disability Status Scale, pyramidal system score, and Barthel Index). CONCLUSIONS In this series a high incidence of patients reported voiding disorder as the presenting symptom of MS. These patients also showed a higher severity of urodynamic disorders. They should be rigorously followed up. Furthermore, our data suggest that although the most common cause of altered bladder control in MS is spinal cord pathology, involvement of cortical centers and/or peripheral neuronal lesions may occur.
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Affiliation(s)
- SCOTT E. LITWILLER
- From the Departments of Urology and Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - ELLIOT M. FROHMAN
- From the Departments of Urology and Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - PHILIPPE E. ZIMMERN
- From the Departments of Urology and Neurology, University of Texas Southwestern Medical Center, Dallas, Texas
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Evans SN, Castleden CM. Neurological disorders in the ageing population and their urological implications. BRITISH JOURNAL OF UROLOGY 1998; 82 Suppl 1:71-8. [PMID: 9883265 DOI: 10.1046/j.1464-410x.1998.0820s1071.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S N Evans
- Continence Clinic, Directorate of Medicine, Leicester General Hospital NHS Trust, UK
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BARBALIAS GEORGEA, NIKIFORIDIS GEORGE, LIATSIKOS EVAGELOSN. VESICOURETHRAL DYSFUNCTION ASSOCIATED WITH MULTIPLE SCLEROSIS: CLINICAL AND URODYNAMIC PERSPECTIVES. J Urol 1998. [DOI: 10.1016/s0022-5347(01)63048-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- GEORGE A. BARBALIAS
- Departments of Urology, and Medical Physics, University of Patras, School of Medicine, Patras, Greece
| | - GEORGE NIKIFORIDIS
- Departments of Urology, and Medical Physics, University of Patras, School of Medicine, Patras, Greece
| | - EVAGELOS N. LIATSIKOS
- Departments of Urology, and Medical Physics, University of Patras, School of Medicine, Patras, Greece
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Gallien P, Robineau S, Nicolas B, Le Bot MP, Brissot R, Verin M. Vesicourethral dysfunction and urodynamic findings in multiple sclerosis: a study of 149 cases. Arch Phys Med Rehabil 1998; 79:255-7. [PMID: 9523775 DOI: 10.1016/s0003-9993(98)90003-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Vesicourethral dysfunction is common in people with multiple sclerosis and results in significant impairment. We studied the clinical and urodynamic findings in such patients to define risk factors for incontinence and upper urinary tract infections. DESIGN AND SETTING A cohort study of 149 patients with multiple sclerosis and urinary symptoms seen in our urodynamic laboratory. INTERVENTION A complete urodynamic study of each patient with urethrocystometry and continuous recording of the urethral sphincter electromyography and assessment of postvoid residual. RESULTS Detrusor hyperreflexia and sphincter dyssynergia were the main dysfunctions. No significant relation between clinical features and urodynamic patterns was found. Women with low maximal urethral pressure were particularly prone to incontinence, which occurred in 69% of the patients. Pyelonephritis was associated with a postvoiding residual urine of > 30% of the functional detrusor capacity, and was found more often in the male population. CONCLUSION Urodynamic assessment of bladder function is critical to direct therapy for urinary complaints in people with multiple sclerosis.
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Affiliation(s)
- P Gallien
- Clinique de Rééducation Fonctionelle, Centre Hospitalier et Universitaire de Rennes, Hôpital Pontchaillou, France
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Ventimiglia B, Patti F, Reggio E, Failla G, Morana C, Lopes M, Savoca F, Consoli C, Reggio A. Disorders of micturition in neurological patients. A clinical study of 786 patients. J Neurol 1998; 245:173-7. [PMID: 9553849 DOI: 10.1007/s004150050200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Our aim was to evaluate the utility and effectiveness of a study protocol for neurological involvement in neurological disorders. We studied a sample of 786 patients with neurological disorders followed by the Neurological Department of Catania University and applied to them a four-step diagnostic protocol. Fifty-six per cent of the sample showed urological functional abnormalities; only 78 patients (9.9%) presented with an organic urological disease. Among the vesicosphincteric dysfunctions, bladder hyperreflexia was the most common pattern with remarkable differences between diseases. The present study demonstrated the utility of a standardized urological protocol in the screening and detection of neurological involvement in neurological diseases. Our protocol showed good specificity and reasonable low costs.
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Les complications urologiques dans la sclérose en plaques: étude des facteurs de risques. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0168-6054(98)80014-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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