1
|
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.
Collapse
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
| |
Collapse
|
2
|
Sartori AM, Kessler TM, Castro-Díaz DM, de Keijzer P, Del Popolo G, Ecclestone H, Frings D, Groen J, Hamid R, Karsenty G, Musco S, Padilla-Fernández B, Pannek J, Schouten N, van der Vorm A, Blok BFM. Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology. Eur Urol 2024; 85:543-555. [PMID: 38594103 DOI: 10.1016/j.eururo.2024.03.026] [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] [Received: 03/03/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Most patients with neurourological disorders require lifelong medical care. The European Association of Urology (EAU) regularly updates guidelines for diagnosis and treatment of these patients. The objective of this review is to provide a summary of the 2024 updated EAU guidelines on neurourology. METHODS A structured literature review covering the timeframe 2021-2023 was conducted for the guideline update. A level of evidence and a strength rating were assigned for each recommendation on the basis of the literature data. KEY FINDINGS AND LIMITATIONS Neurological conditions significantly affect urinary, sexual, and bowel function, and lifelong management is required for neurourological patients to maintain their quality of life and prevent urinary tract deterioration. Early diagnosis and effective treatment are key, and comprehensive clinical assessments, including urodynamics, are crucial. Management should be customised to individual needs and should involve a multidisciplinary approach and address sexuality and fertility. Lifelong monitoring and follow-up highlight the importance of continuous care for neurourological patients. CONCLUSIONS AND CLINICAL IMPLICATIONS The 2024 EAU guidelines on neurourology provide an up-to-date overview of available evidence on diagnosis, treatment, and follow-up for neurourological patients. PATIENT SUMMARY Neurological disorders very frequently affect the lower urinary tract and sexual and bowel function and patients need lifelong management. We summarise the updated European Association of Urology guidelines on neurourology to provide patients and caregivers with the latest insights for optimal health care support.
Collapse
Affiliation(s)
- Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David M Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Peter de Keijzer
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giulio Del Popolo
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | | | - Dennis Frings
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Stefania Musco
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Jürgen Pannek
- Neuro-Urology Department, Swiss Paraplegic Center, Nottwil, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Stritt K, Lucca I, Roth B, Grilo N. Is EDSS Enough to Predict Risk of Upper Urinary Tract Damage in Patients with Multiple Sclerosis? Biomedicines 2022; 10:biomedicines10123001. [PMID: 36551757 PMCID: PMC9775948 DOI: 10.3390/biomedicines10123001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Lower urinary tract dysfunction is often observed in patients with multiple sclerosis (MS) and may be responsible for an increased risk of upper urinary tract (UUT) damage. Although there are well-known urodynamic risk factors for UUT damage, no clinical prediction parameters are clearly identified. We aimed to confirm the accuracy of the Expanded Disability Status Scale (EDSS) in predicting urodynamic risk factors for UUT deterioration and to assess other clinical parameters potentially predicting urodynamic risk factors. We retrospectively reviewed 201 patients with MS referred for primary neuro-urological work-up, including a video-urodynamic study (VUDS) from August 2009 to February 2020. Multivariate modeling revealed EDSS, male gender, and a number of LUTS as clinical parameters significantly associated with urodynamic risk factors for UUT damage (p = 0.06, p = 0.01, p = 0.02, respectively). A nomogram combining EDSS, male gender, and a number of different LUTS was created to predict the presence of at least one urodynamic risk factor for UUT damage. In conclusion, the presence of high EDSS combined with male gender and several different LUTS is significantly associated with urodynamic risk factors and can be used to stratify MS patients for further neuro-urological assessment and treatment.
Collapse
|
6
|
Lucchini M, Del Giacomo P, De Arcangelis V, Nociti V, Bianco A, De Fino C, Presicce G, Cicia A, Carlomagno V, Mirabella M. The Expanding Role of the Infectious Disease Expert in the Context of the MS Centre. J Pers Med 2022; 12:jpm12040591. [PMID: 35455707 PMCID: PMC9026290 DOI: 10.3390/jpm12040591] [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: 02/26/2022] [Revised: 03/26/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The complexity of the MS patient’s management is constantly growing. Consequently, the MS care unit requires a multidisciplinary approach, including an infectious disease specialist to minimise the risk of infectious complications related both to the disease and DMTs. Materials and methods: We retrospectively evaluated the infectious disease consultations performed from 2015 to 2019 in our MS centre. Results: We identified 107 patients with at least one infectious disease consultation out of 1088 patients. We found a progressive increase in the number of consultations from 2015 to 2019. Nearly half of the consultations were requested at the time of starting MS treatment. The most frequent requests were represented by chronic or acute infections. The most prevalent infectious agents were Herpesviridae and Mycobacterium tuberculosis. Antibiotic or antiviral treatment and prophylactic treatment or vaccination represented together the most frequent outcomes of the consultations. Finally, a treatment delay was significantly associated with the advice of a prophylactic treatment or of a vaccination. Conclusion: There is an increasing awareness of the potential infectious complications of MS and of exposure to DMTs. The interaction between the MS neurologist and infectious disease specialist is fundamental to minimise the infectious risk related to the disease and to the DMTs, with a progressive shift from complication management to a broader prevention workup at the time of MS diagnosis, including both vaccination and prophylactic treatments.
Collapse
Affiliation(s)
- Matteo Lucchini
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.D.A.); (V.N.); (A.B.); (C.D.F.); (A.C.); (V.C.); (M.M.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, CERSM, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-30155390
| | - Paola Del Giacomo
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Valeria De Arcangelis
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.D.A.); (V.N.); (A.B.); (C.D.F.); (A.C.); (V.C.); (M.M.)
| | - Viviana Nociti
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.D.A.); (V.N.); (A.B.); (C.D.F.); (A.C.); (V.C.); (M.M.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, CERSM, 00168 Rome, Italy
| | - Assunta Bianco
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.D.A.); (V.N.); (A.B.); (C.D.F.); (A.C.); (V.C.); (M.M.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, CERSM, 00168 Rome, Italy
| | - Chiara De Fino
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.D.A.); (V.N.); (A.B.); (C.D.F.); (A.C.); (V.C.); (M.M.)
| | | | - Alessandra Cicia
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.D.A.); (V.N.); (A.B.); (C.D.F.); (A.C.); (V.C.); (M.M.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, CERSM, 00168 Rome, Italy
| | - Vincenzo Carlomagno
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.D.A.); (V.N.); (A.B.); (C.D.F.); (A.C.); (V.C.); (M.M.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, CERSM, 00168 Rome, Italy
| | - Massimiliano Mirabella
- UOC Neurologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.D.A.); (V.N.); (A.B.); (C.D.F.); (A.C.); (V.C.); (M.M.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, CERSM, 00168 Rome, Italy
| |
Collapse
|
7
|
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.
Collapse
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.)
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Domurath B, Flachenecker P, Henze T, Feneberg W, Brandt A, Kurze I, Kirschner-Hermanns R, Kaufmann A, Bremer J, Vonthien M, Ratering K, Schäfer C, Vance WN, Schmidt P. [Current aspects of neurogenic dysfunctions of the lower urinary tract in multiple sclerosis]. DER NERVENARZT 2021; 92:349-358. [PMID: 33399923 PMCID: PMC8026406 DOI: 10.1007/s00115-020-01046-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND In the clinical management of patients with multiple sclerosis (MS), the challenge is to make an early diagnosis and initiate adequate treatment of neurogenic disorders of the lower urinary tract (NLUTD). Various national guidelines provide practical recommendations which are sometimes discordant. OBJECTIVE To develop a simple evidence-based algorithm for detecting NLUTD in patients with MS that could be taken as a principle for deriving therapeutic consequences. MATERIAL AND METHODS A prospective multicenter study was initiated as a direct result of two multidisciplinary conferences. The aim was to identify statistically and clinically relevant parameters for the routine diagnosis of NLUTD in patients with MS. Urodynamic abnormalities served as the gold standard. At three subsequent consensus conferences, the results of the study were discussed, a diagnostic algorithm was developed and consensus was reached on a first-line treatment. RESULTS AND DISCUSSION The proposed algorithm enables the detection of NLUTD in patients with MS with the help of four statistically significant predictors: 1) the residual urine volume, 2) the number of urinary tract infections (UTI) within the last 6 months, 3) the standardized micturition frequency and 4) the presence/absence of urinary incontinence. The newly developed algorithm has proved to be efficient with the following results: approximately 75% of the patients do not need a urodynamic examination for a first-line treatment decision. In 25% of cases, urodynamic examinations are essential for an adequate treatment decision. Routine assessments include the patient medical history, residual urine volume measurement, a micturition diary and a uroflowmetry (optional).
Collapse
Affiliation(s)
- Burkhard Domurath
- Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6A, 14547, Beelitz Heilstätten, Deutschland.
| | - Peter Flachenecker
- Neurologisches Rehabilitationszentrum Quellenhof, Bad Wildbad, Deutschland
| | - Thomas Henze
- Praxis für Neurologie Dr. Blersch, Regensburg, Deutschland
| | - Wolfgang Feneberg
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gemeinnützige GmbH, Berg, Deutschland
| | - Anna Brandt
- Neurologisches Zentrum, Segeberger Kliniken, Bad Segeberg, Deutschland
| | - Ines Kurze
- Querschnittgelähmten-Zentrum, Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka GmbH, Bad Berka, Deutschland
| | - Ruth Kirschner-Hermanns
- Sektion Neurourologie, Klinik für Urologie und Kinderurologie, Universitätsklinikum Bonn und Neuro-Urologie, Neurologisches Rehabilitationszentrum der "Godeshöhe" e. V., Bonn, Deutschland
| | - Albert Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH, Mönchengladbach, Deutschland
| | - Jörn Bremer
- Querschnittgelähmtenzentrum, BDH Klinik Greifswald gGmbH, Greifswald, Deutschland
| | | | | | - Christoph Schäfer
- Rehaklinik für Neurologie und Orthopädie, Johanniter-Klinik am Romberg, Dortmund, Deutschland
| | - Will Nelson Vance
- Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6A, 14547, Beelitz Heilstätten, Deutschland
| | - Paul Schmidt
- Statistik, Große Seestraße, 813086, Berlin, Deutschland
| |
Collapse
|
10
|
Zhang T, Goodman M, Zhu F, Healy B, Carruthers R, Chitnis T, Weiner H, Cai T, De Jager P, Tremlett H, Xia Z. Phenome-wide examination of comorbidity burden and multiple sclerosis disease severity. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/6/e864. [PMID: 32817202 PMCID: PMC7673286 DOI: 10.1212/nxi.0000000000000864] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022]
Abstract
Objective We assessed the comorbidity burden associated with multiple sclerosis (MS) severity by performing a phenome-wide association study (PheWAS). Methods We conducted a PheWAS in 2 independent cohorts: a discovery (Boston, United States; 1993–2014) and extension cohort (British Columbia, Canada; 1991–2008). We included adults with MS, ≥1 Expanded Disability Status Scale (EDSS) score, and ≥1 International Classification of Diseases (ICD) code other than MS. We calculated the Multiple Sclerosis Severity Score (MSSS) using the EDSS. We mapped ICD codes into PheCodes (phenotypes), using a published system with each PheCode representing a unique medical condition. Association between the MSSS and the presence of each condition was assessed using logistic regression adjusted for covariates. Results The discovery and extension cohorts included 3,439 and 4,876 participants, respectively. After Bonferroni correction and covariate adjustments, a higher MSSS was associated with 37 coexisting conditions in the discovery cohort. Subsequently, 16 conditions, including genitourinary, infectious, metabolic, epilepsy, and movement disorders, met the reporting criteria, reaching the Bonferroni threshold of significance with the same direction of effect in the discovery and extension cohort. Notably, benign neoplasm of the skin was inversely associated with the MSSS. Conclusion The phenome-wide approach enabled a systematic interrogation of the comorbidity burden and highlighted clinically relevant medical conditions associated with MS severity (beyond MS-specific consequences) and defines a roadmap for comprehensive investigation of comorbidities in chronic neurologic diseases. Further prospective investigation of the bidirectional relationship between disability and comorbidities could inform the individualized patient management.
Collapse
Affiliation(s)
- Tingting Zhang
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Matthew Goodman
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Feng Zhu
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Brian Healy
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Robert Carruthers
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Tanuja Chitnis
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Howard Weiner
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Tianxi Cai
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Philip De Jager
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Helen Tremlett
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA
| | - Zongqi Xia
- From the Department of Health Services (T.Z.), Policy and Practice, Brown University, Providence, RI; Department of Biostatistics (M.G., T. Cai), Harvard T. H. Chan School of Public Health, Boston, MA; Department of Medicine (Neurology) (F.Z., R.C., H.T.), and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada; Department of Neurology (B.H., T. Chitnis, H.W., P.D.J., Z.X.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (P.D.J.), Columbia University, New York, NY; and Department of Neurology (Z.X.), University of Pittsburgh, PA.
| |
Collapse
|
11
|
Kovacevic N, Lopes NN, Raffee S, Atiemo HO. Predicting Upper Urinary Tract Risk in the Neurogenic Bladder Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
12
|
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.
Collapse
|
13
|
Akakpo W, Chartier-Kastler E, Joussain C, Denys P, Lubetzki C, Phé V. Outcomes of ileal conduit urinary diversion in patients with multiple sclerosis. Neurourol Urodyn 2020; 39:771-777. [PMID: 31951678 DOI: 10.1002/nau.24279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/05/2020] [Indexed: 12/23/2022]
Abstract
AIM The objective of this study was to report the long-term outcomes and complications of patients with multiple sclerosis (MS) who underwent noncontinent urinary diversion to treat lower urinary tract symptoms (LUTS). MATERIAL AND METHODS A retrospective study included all adult patients with MS who underwent an ileal conduit urinary diversion between 2000 and 2015. Early postoperative complications were reported as well as long-term complications, reoperation rates, and renal function. RESULTS Overall, 91 patients were included. The surgery was indicated for refractory urinary incontinence (n = 73), renal failure (n = 8), major perineal skin ulcer due to urinary incontinence (n = 6), and recurrent urinary tract infections (n = 4). The median follow-up was 50 months (range, 3-158 months). A significant reduction (P < .05) of postoperative nonobstructive pyelonephritis rate was observed. There was no significant difference between preoperative and postoperative renal function (P = .32). Early postoperative complications were reported in 24 patients (26%): 4 Clavien I, 6 Clavien II, 9 Clavien III, 4 Clavien IV, and 1 Clavien V. Nine patients required reoperation for these complications (9.9%). Late complications were reported in 28 patients (30.8%): 8 ureteral anastomosis stenosis, 2 stoma stenosis, 2 incisional hernias, 6 kidney or ureteral lithiasis, and 10 pyelonephritis. Among them, 15 patients (16.5%) required reoperation for late complications. CONCLUSION Noncontinent urinary diversion using ileal conduit appears to be an effective end-stage solution in MS patients. The perioperative morbidity rate of 26% and the late complication rate of 31% should be considered to better inform patients before the surgery.
Collapse
Affiliation(s)
- William Akakpo
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Charles Joussain
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital Academic Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital Academic Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Catherine Lubetzki
- Department of Neurology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Executive summary. Can Urol Assoc J 2019; 13:156-165. [PMID: 31199234 DOI: 10.5489/cuaj.6041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
| |
Collapse
|
16
|
Mahmudi L, Moslemirad M, Dabestani B, Shohani M, Azami M. Clinical and demographic features in Iranian multiple sclerosis patients: a systematic review and meta-analysis. FUTURE NEUROLOGY 2019. [DOI: 10.2217/fnl-2018-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: This study was conducted to determine the clinical and demographic features in Iranian multiple sclerosis (MS) patients including clinical courses, positive MS family history, disability and age of disease onset. Materials & methods: All stages of the study were reported according to the PRISMA guidelines. A systematic review of published literature in Persian and English journals with a comprehensive search was conducted on English international databases including Scopus, PubMed/Medline, Cochrane Library, Science Direct, Web of Science, Embase, PsycINFO, as well as the Google Scholar search engine and national databases. Results: The prevalence of clinical courses of relapsing remitting, primary progressive, secondary progressive and relapsing progressive in Iranian patients with MS was 77.1% (95% CI: 72.2–81.3), 6.2% (95% CI: 4.1–9.2), 9.5% (95% CI: 6.8–13.1) and 0.4% (95% CI: 0.2–0.8), respectively. Positive family history of MS in Iranian MS patients was 8.9% (95% CI: 6.9–11.4). The mean age of disease onset was 28.9 years (95% CI: 27.8–30.1). Conclusion: The results of this meta-analysis in an Iranian population can provide useful information for neurologists and healthcare.
Collapse
Affiliation(s)
- Leily Mahmudi
- School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Moslem Moslemirad
- School of Nursing & Midwifery, Yasuj University of Medical Science, Yasuj, Iran
| | - Bafrin Dabestani
- Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Shohani
- Department of Nursing, Faculty of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Milad Azami
- School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| |
Collapse
|
17
|
Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text. Can Urol Assoc J 2019; 13:E157-E176. [PMID: 30763235 DOI: 10.5489/cuaj.5912] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW Multiple sclerosis (MS) is the most frequent neuroinflammatory disease of the central nervous system and is commonly associated with lower urinary tract (LUT) dysfunction. As a consequence, health-related quality of life is often impaired and the upper urinary tract might be at risk for damage. The aim of this review is to give an overview of current treatment options for LUT dysfunction in patients with MS. RECENT FINDINGS The treatment is tailored to the type of dysfunction-storage or voiding dysfunction-beginning with conservative treatment options and ending with invasive therapies and surgery. Additionally, alternative options, e.g., different intravesical therapies or cannabinoids, have been evaluated in recent years with promising results. Current available therapies offer different possible treatments for LUT dysfunction in patients with MS. They address either voiding or storage dysfunction and therefore ameliorate LUT symptoms improve quality of life and protect the upper urinary tract.
Collapse
Affiliation(s)
- Jure Tornic
- Department of Uro-Neurology, The National Hospital For Neurology and Neurosurgery and UCL Institute for Neurology, Queen Square, London, WC1N 3BG, UK.
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital For Neurology and Neurosurgery and UCL Institute for Neurology, Queen Square, London, WC1N 3BG, UK
| |
Collapse
|
19
|
Tornic J, Sartori AM, Gajewski JB, Cox A, Schneider MP, Youssef NA, Mordasini L, Chartier-Kastler E, Bachmann LM, Kessler TM. Catheterization for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: A systematic review. A report from the Neuro-Urology Promotion Committee of the International Continence Society (ICS). Neurourol Urodyn 2018; 37:2315-2322. [PMID: 29917273 DOI: 10.1002/nau.23733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/31/2018] [Indexed: 11/07/2022]
Abstract
AIM To systematically assess all available evidence on efficacy and safety of catheterization for treating neurogenic lower urinary tract dysfunction (NLUTD) in patients with multiple sclerosis (MS). METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by electronic search of Embase, Medline, Scopus, Cochrane register (last search March 3, 2018) and by screening of reference lists and reviews. RESULTS After screening 7'015 articles, we included four studies (one prospective and two retrospective cohort studies, one retrospective cross-sectional study), in which a total of 445 patients were enrolled. No randomized controlled trial was available. Catheterization substantially increased quality of life, post void residual, and incontinence episodes in all included studies. Pooling of data for meta-analysis was not possible due to the heterogeneity of reported outcomes. Adverse events were reported in two studies only. Risk of bias and confounding was intermediate. CONCLUSIONS Preliminary data suggests beneficial effects of catheterization on the urological outcome in patients with MS. However, although intermittent and indwelling catheterization is used frequently in daily clinical practice in the MS population, the evidence base is very limited and well-designed, properly sampled, and powered studies are urgently needed.
Collapse
Affiliation(s)
- Jure Tornic
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Andrea M Sartori
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.,Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marc P Schneider
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.,Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.,Department of Urology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nadim A Youssef
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Livio Mordasini
- Department of Urology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Emmanuel Chartier-Kastler
- Department of Urology, Groupe Hospitalier Pitié-Salpêtrière, Medical School Sorbonne University, Paris, France
| | | | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| |
Collapse
|
20
|
Zeng C, Du S, Han Y, Fu J, Luo Q, Xiang Y, Chen X, Luo T, Li Y, Zheng Y. Optic radiations are thinner and show signs of iron deposition in patients with long-standing remitting-relapsing multiple sclerosis: an enhanced T 2*-weighted angiography imaging study. Eur Radiol 2018; 28:4447-4454. [PMID: 29713769 PMCID: PMC6132724 DOI: 10.1007/s00330-018-5461-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/09/2018] [Accepted: 04/05/2018] [Indexed: 11/23/2022]
Abstract
Objective This study aimed to investigate iron deposition and thickness and signal changes in optic radiation (OR) by enhanced T2*-weighted angiography imaging (ESWAN) in patients with relapsing-remitting multiple sclerosis (RRMS) with unilateral and bilateral lesions or no lesions. Methods Fifty-one RRMS patients (42 patients with a disease duration [DD] ≥ 2 years [group Mor], nine patients with a DD < 2 years [group Les]) and 51 healthy controls (group Con) underwent conventional magnetic resonance imaging (MRI) and ESWAN at 3.0 T. The mean phase value (MPV) of the OR was measured on the phase image, and thickness and signal changes of the OR were observed on the magnitude image. Results The average MPVs for the OR were 1,981.55 ± 7.75 in group Mor, 1,998.45 ± 2.01 in group Les, and 2,000.48 ± 5.53 in group Con. In group Mor, 28 patients with bilateral OR lesions showed bilateral OR thinning with a heterogeneous signal, and 14 patients with unilateral OR lesions showed ipsilateral OR thinning with a heterogeneous signal. In the remaining nine patients without OR lesions and in group Con, the bilateral OR had a normal appearance. In the patients, a negative correlation was found between DD and OR thickness and a positive correlation was found between MPV and OR thickness. Conclusions We confirmed iron deposition in the OR in the RRMS patients, and the OR thickness was lower in the patients than in the controls. Key Points • Enhanced T2*-weighted magnetic resonance angiography (ESWAN) provides new insights into multiple sclerosis (MS). • Focal destruction of the optic radiation (OR) is detectable by ESWAN. • Iron deposition in OR can be measured on ESWAN phase image in MS patients. • OR thickness was lower in the patients than in the controls. • Iron deposition and thickness changes of the OR are associated with disease duration. Electronic supplementary material The online version of this article (10.1007/s00330-018-5461-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Chun Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Silin Du
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yongliang Han
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Jialiang Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qi Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yayun Xiang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaoya Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Tianyou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Yineng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| |
Collapse
|