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Tota V, Briganti G, Ris L. Algorithms for the first-line management of bladder, bowel and sexual dysfunction in multiple sclerosis: Present and future. Mult Scler Relat Disord 2024; 91:105884. [PMID: 39321547 DOI: 10.1016/j.msard.2024.105884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/14/2024] [Accepted: 09/08/2024] [Indexed: 09/27/2024]
Abstract
INTRODUCTION Neurogenic lower urinary tract (NLUTD), bowel (NBD), and sexual dysfunction (SD) are commonly observed in patients with (pw) multiple sclerosis (MS) and diminish the patients' quality of life (QoL). This systematic review aim to evaluate and discuss the current algorithms for the management of these issues. METHODS A systematic review was conducted on the PubMed in June 2024. The primary search criterion was the presence of the term 'algorithm/s' or 'management/ing' in the title and/or abstract, followed by the MeSH term 'multiple sclerosis' and a combination of free-text keywords referring to NLUTD, NBD or SD. RESULTS Fifteen articles regarding NLUTD were considered eligible, only one regarding SD while none addressed NBD. DISCUSSION Numerous studies emphasize the profound impact of urinary and bowel symptoms on the QoL and morbidity in pwMS. Few algorithms addressing NLUTD are designed for first-line physicians and addresses the key priorities in MS care. Specific approaches to NBD management in pwMS are lacking. Screening for SD requires a structured assessment to deliver appropriate solutions. CONCLUSION NLUTD, NBD, and SD are underdiagnosed and undertreated. The implementation of straightforward algorithms for first-line physicians could enhance the management of these common issues, improve the QoL, reduce costs, and ensure appropriate referral to specialists.
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Affiliation(s)
- Vito Tota
- HELORA Hospital Network, Mons, Belgium; Department of Neuroscience, Research Institute for Health Science and Technology, Université de Mons, Belgium.
| | - Giovanni Briganti
- Department of Computational Medicine and Neuropsychiatry, Faculty of Medicine, Université de Mons, Belgium
| | - Laurence Ris
- Department of Neuroscience, Research Institute for Health Science and Technology, Université de Mons, Belgium
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Kurze I, Jaekel AK. [Neuro-urological diagnostics and treatment of non-traumatic/degenerative neurogenic lower urinary tract dysfunction exemplified by multiple sclerosis]. Aktuelle Urol 2024; 55:315-325. [PMID: 38653466 DOI: 10.1055/a-2281-7924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Neurogenic lower urinary tract dysfunction in multiple sclerosis is often underestimated, underdiagnosed, and inadequately treated. Depending on the course of the disease and the location of neural damage, it occurs with varying frequency and types of impairment of urine storage and voiding function. Symptoms such as urinary incontinence, recurrent urinary tract infections, urgency, pollakiuria, reduced urinary flow, hesitancy as well as postvoid residual urine may occur. However, the symptoms do not allow any conclusions to be drawn about the underlying type of neurogenic lower urinary tract dysfunction. Although numerous data, publications, and guidelines are available on this topic today, there continues to be a lack of standardized screening parameters and algorithms that have been tested in prospective studies for multiple sclerosis. This article presents the current diagnostic and therapeutic options of neurogenic lower urinary tract dysfunction in multiple sclerosis. A crucial issue is the initial delay in diagnosis, not least due to a lack of communication between neurologists and urologists. Initial indicators of the presence of neurogenic lower urinary tract dysfunction can be obtained by actively asking about the subjective presence of symptoms such as urinary incontinence or the occurrence of urinary tract infections. However, a subjective lack of symptoms does not rule out a neurogenic lower urinary tract dysfunction. Regardless of the stage of the disease, an early and individualized neuro-urological diagnosis and treatment should be implemented. All aspects of the damage and the extent of functional deficits in other organ systems caused by multiple sclerosis must be included in this neuro-urological treatment decision, which requires a consistent interdisciplinary exchange between neurologists, general practitioners, and urologists. This interdisciplinary and interprofessional way of thinking and acting is key for an optimal treatment using the numerous therapeutic procedures. Lifelong, individual, risk-adapted urological care for the early detection and prevention of neuro-urological complications should be offered to persons with multiple sclerosis.
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Affiliation(s)
- Ines Kurze
- Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka Gmbh, Bad Berka, Germany
| | - Anke K Jaekel
- Klinik für Urologie und Kinderurologie, Sektion Neuro-Urologie, Universitätsklinikum Bonn, Bonn, Germany
- Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshoehe GmbH, Bonn, Germany
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Mazeaud C, Choksi D, Tran K, Schott B, Jang Y, Salazar BH, Karmonik C, Khavari R. What clinical parameter strongly associates white matter tract alterations in a Multiple Sclerosis population with voiding dysfunction? A prospective exploratory study. JU OPEN PLUS 2024; 2:e00001. [PMID: 38883864 PMCID: PMC11178290 DOI: 10.1097/ju9.0000000000000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Purpose To correlate clinical and urodynamics parameters in Multiple Sclerosis patients (MS) presenting Lower Urinary Tract Symptoms (LUTS) with both Expanded Disability Status Scale (EDSS) and changes in white matter integrity as seen on Diffusion Tensor Images (DTI). LUTS worsen throughout MS, as does lesion burden. We investigated which symptoms correlated best with structural changes in white matter structure. Materials and Methods Ten adult women >18 years were recruited with stable MS for ≥3 months and voiding dysfunction defined as %PVR/BV > 20%. Patients participated in a clinical Urodynamic Study (UDS) and completed several questionnaires (i.e., HAM, AUASS, NBS-QoL). DTI images were acquired using a 7-Tesla Siemens MAGNETOM Terra MRI scanner. DTI maps were constructed, and individual patients were co-registered with the ICBM-DTI-81 white matter atlas to extract fractional anisotropy (FA) and mean diffusivity (MD). Pearson's correlation test was performed between each WMT and clinical parameters and between clinical parameters and the EDSS score as well. P-values < 0.05 were considered significant. Results Of the clinical parameters, %PVR/BV obtained from the average of multiple un-instrumented uroflow assessments had significant correlations to the greatest number of WMTs. Furthermore, we observed that in all recorded clinical parameters, %PVR/BV was the only significant parameter correlated to the EDSS score. Conclusion This study demonstrates that %PVR/BV can be used as an objective parameter to gauge WMT changes and disease progression in MS patients. Future studies are needed to refine this model.
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Affiliation(s)
- C. Mazeaud
- Houston Methodist Hospital, Department of Urology, Houston, Texas, USA
- Nancy University Hospital, Department of Urology, IADI-UL-INSERM (U1254), Nancy, France
| | - Darshil Choksi
- College of Medicine, Texas A&M University, Houston, Texas, USA
| | - Khue Tran
- Houston Methodist Hospital, Department of Urology, Houston, Texas, USA
| | - Bradley Schott
- College of Medicine, Texas A&M University, Houston, Texas, USA
| | - Yongchang Jang
- College of Medicine, Texas A&M University, Houston, Texas, USA
| | - B. H. Salazar
- Houston Methodist Hospital, Department of Urology, Houston, Texas, USA
| | - C. Karmonik
- Houston Methodist Research Institute, MRI Core, Houston, Texas, USA
| | - R. Khavari
- Houston Methodist Hospital, Department of Urology, Houston, Texas, USA
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Jaekel AK, Watzek J, Nielsen J, Butscher AL, Zöhrer P, Schmitz F, Kirschner-Hermanns RKM, Knüpfer SC. Neurogenic Lower Urinary Tract Symptoms, Fatigue, and Depression-Are There Correlations in Persons with Multiple Sclerosis? Biomedicines 2023; 11:2193. [PMID: 37626690 PMCID: PMC10452515 DOI: 10.3390/biomedicines11082193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
The symptoms of multiple sclerosis (MS) frequently include fatigue, depression, and neurogenic lower urinary tract symptoms (LUTS), causing severe burdens on affected individuals. The relationships between these symptoms have not been intensively researched and there are no studies on the detailed influence of the different neurogenic LUTS. We aimed to investigate the relationships between fatigue, depression, and neurogenic LUTS as recorded in bladder diaries by persons with MS. We analyzed the bladder diaries of 274 people and their scores on the Fatigue Scale for Motor and Cognitive Functions and the Centre for Epidemiologic Studies Depression Scale (German version). The neurogenic LUTS were defined as urgency, reduced voided volume, increased standardized voiding frequency, nocturia, and urinary incontinence. Those suffering from incontinence, nocturia, reduced voided volume, or urgency had higher fatigue scores compared to those without these symptoms. Those with nocturia showed significantly higher scores for depression. The severity of urgency and voided volume had the greatest effect on the severity of individuals' fatigue and depression levels. With increasing urgency, the risk of clinically significant fatigue and depression was expected to increase. Urgency and voided volume correlated most with fatigue and depression. A prospective longitudinal study investigating fatigue/depression after the successful treatment of neurogenic LUTS is needed to clarify causality and offer possible treatment options for fatigue and depression.
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Affiliation(s)
- Anke K. Jaekel
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Department of Neuro-Urology, Johanniter Neurological Rehabilitation Center Godeshoehe GmbH, 53177 Bonn, Germany
| | - Julius Watzek
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Jörn Nielsen
- Department of Cognitive Rehabilitation, Neurological Rehabilitation Center Godeshoehe GmbH, 53177 Bonn, Germany
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Anna-Lena Butscher
- Department of Neuro-Urology, Johanniter Neurological Rehabilitation Center Godeshoehe GmbH, 53177 Bonn, Germany
| | - Pirmin Zöhrer
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Franziska Schmitz
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Ruth K. M. Kirschner-Hermanns
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Department of Neuro-Urology, Johanniter Neurological Rehabilitation Center Godeshoehe GmbH, 53177 Bonn, Germany
| | - Stephanie C. Knüpfer
- Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
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Jaekel AK, Winterhagen FI, Zeller FL, Butscher AL, Knappe FK, Schmitz F, Hauk C, Stein J, Kirschner-Hermanns RKM, Knüpfer SC. Neurogenic Lower Urinary Tract Dysfunction in Asymptomatic Patients with Multiple Sclerosis. Biomedicines 2022; 10:biomedicines10123260. [PMID: 36552016 PMCID: PMC9775954 DOI: 10.3390/biomedicines10123260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD) in asymptomatic patients with MS has been described in preliminary studies, but specific investigations of this topic are rare. Many authors advise early diagnosis and treatment of NLUTD in patients with MS. In contrast, clinical practice and different guidelines recommend neuro-urological diagnostics only in the presence of symptoms. Our aim was to investigate the characteristics of NLUTD and the correlations of clinical parameters with NLUTD in asymptomatic patients with MS. We evaluated bladder diaries, urodynamic findings, and therapy proposals. Correlations of the voided volume, voiding frequency, urinary tract infections, and uroflowmetry including post-void residual with the urodynamic findings were determined. In our study, 26% of the patients were asymptomatic. Of these, 73.7% had urodynamic findings indicative of NLUTD, 21.1% had detrusor overactivity, 13.2% had detrusor underactivity, 13.2% detrusor overactivity and detrusor sphincter dyssynergia, and 57.9% had radiologically abnormal findings of the bladder. No patients presented low bladder compliance or renal reflux. Clinical parameters from the bladder diary and urinary tract infections were found to be correlated with NLUTD, and the absence of symptoms did not exclude NLUTD in patients with MS. We observed that urinary tract damage is already present in a relevant proportion. Based on our results, we recommend that patients with MS be screened for NLUTD regardless of the subjective presence of urinary symptoms or the disease stage.
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Affiliation(s)
- Anke K. Jaekel
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany
- Correspondence: ; Tel.: +0049-179-9033123
| | - Franziska I. Winterhagen
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Federico L. Zeller
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany
| | - Anna-Lena Butscher
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany
| | - Franziska K. Knappe
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Franziska Schmitz
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Christopher Hauk
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Johannes Stein
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Ruth K. M. Kirschner-Hermanns
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Neuro-Urology, Johanniter Neurological Rehabilitation Center ‘Godeshoehe e.V.’, 53177 Bonn, Germany
| | - Stephanie C. Knüpfer
- Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
- Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany
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de Seze M. Surveillance urodynamique annuelle dans la SEP : Ô que oui ! Prog Urol 2022; 32:485-486. [DOI: 10.1016/j.purol.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
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Editorial of Special Issue “Multiple Sclerosis: From Diagnostic Biomarkers to Imaging and Clinical Predictors”. Diagnostics (Basel) 2022; 12:diagnostics12020482. [PMID: 35204573 PMCID: PMC8871414 DOI: 10.3390/diagnostics12020482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
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