Micturition disorders in multiple sclerosis patients: neurological, neurourodynamic and magnetic resonance findings

Prevalence of Lower Urinary Tract Symptoms in People with Multiple Sclerosis: A Systematic Review and Meta-analysis

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.

Autonomic disorders in multiple sclerosis

Multiple sclerosis is an inflammatory disease leading to disseminated lesions of the central nervous system resulting in both somatomotor and autonomic disturbances. These involve the central centers of the autonomic nervous system, as well as the automatic control and pathway systems. All autonomic functions may be disordered individually or in combined form. There is no other disease with a clinical picture so multifaceted. Besides cardiovascular dysfunctions disorders of bladder and rectum have become apparent. Somatomotor and autonomic disturbances occur with similar frequency; however the focused exam often heavily favors somatomotor symptoms. Autonomic disturbances should primarily be taken into account on history taking and clinical examination. Individual diagnosis and treatment is a secondary feature. Impairments of the autonomic nervous systems in multiple sclerosis are frequently overlooked.

Disorders of micturition in neurological patients. A clinical study of 786 patients

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.