MS bladder check tool: Development and validation of a patient awareness tool to facilitate timely management of lower urinary tract dysfunction due to multiple sclerosis

BACKGROUND

Lower urinary tract dysfunction impacts quality of life of people with MS; often, symptoms are 'lived with' or deprioritised by healthcare providers (HCPs). Consequently, patients must be given the skills they need to become confident in managing their illness and enhance their involvement in the process.

OBJECTIVE

To develop and validate a self-assessment tool to help people with MS become more aware of their bladder symptoms and prompt contact with their HCP to facilitate timely management and specialist referral, if required.

METHODS

The 'MS bladder check tool' was developed by a multidisciplinary panel of specialist advisors. Consensus meetings and pilot testing were conducted to design and evolve the tool into a series of nine questions, using population-appropriate language, and covering all aspects of bladder dysfunction in MS. The tool was then validated by an international, multidisciplinary team of experts.

RESULTS

Validity was rated 'excellent' for all questions indicating that the MS bladder check tool is an appropriate method of highlighting bladder problems in people with MS.

CONCLUSION

The MS bladder check tool is simple, easy-to-use, and empowers patients to take charge of their urinary tract health, aiming to improve the management of MS and, ultimately, patient quality of life.

Stimulation of the Tibial nerve Repetitively to Improve Incontinence in Parkinson's Electronically (STRIPE trial): a randomised control trial of tibial nerve stimulation for bladder symptoms in Parkinson's disease using a self-contained wearable device

Background

Bladder symptoms are common in Parkinson’s disease (PD), affecting half of all individuals. These have significant impact on quality of life as well as implications for morbidity, contributing to falls and hospital admission. The treatment of bladder symptoms can be complicated by the tendency to side-effects in people with PD including cognitive impairment and gait instability with anti-muscarinics. The development of new, better treatments is therefore warranted. Tibial nerve stimulation is a form of neuromodulation demonstrated to improve overactive bladder symptoms in non-neurogenic cohorts. Previously requiring hospital attendance, we aim to explore the use of this intervention using a simple device that can be used by patients at home.

Methods

STRIPE is a phase II randomised control trial of tibial nerve stimulation delivered by the Geko™ device, a small, self-adhesive neuromuscular stimulation device currently used for thromboembolism prophylaxis post-surgery. Active tibial nerve stimulation will be compared to sham stimulation, with participants blinded to treatment allocation and undertaking outcome assessment whilst still blinded. Participants will be asked to self-administer stimulation at home twice per week, for 30 min per session, over the course of 3 months. Primary outcome measure will be the International Consultation on Incontinence Overactive Bladder Questionnaire (OAB) at week 12. Secondary outcomes will include pre- and post-intervention bladder diary (frequency, urgency episodes, nocturia), patient perception of global change, bowel function and bladder-related quality of life. Participants will be recruited from the Proactive Integrated Management and Empowerment (PRIME) cross-sectional trial in which participants have been screened for bladder symptoms and invited to take part, as well as clinician referral from around the region.

Discussion

This trial will involve a randomised control trial of a novel and easy to use method of delivering tibial nerve stimulation for PD in the patient’s own home. This may potentially have huge benefit, avoiding the problems with side effects that can be seen with anti-muscarinics and providing a new potential modality of treatment.

Trial registration

ISRCTN11484954. Registered on 22 June 2021.

Cauda equina syndrome: false-positive diagnosis of neurogenic bladder can be reduced by multichannel urodynamic study

BACKGROUND

The present consensus suggests urgent surgical decompression if clinical features of cauda equina syndrome (CES) are supported by MRI evidence of pressure on cauda equina. However, clinical diagnosis has a high false-positive rate and MRI is a poor indicator. Though urodynamic studies (UDS) provide objective information about the lower urinary tract symptoms experienced by patients including neurogenic bladder, its role in the diagnosis of CES is not established.

OBJECTIVE

To evaluate the ability of an objective urological assessment protocol using uroflowmetry + USG-PVR as screening test and invasive UDS as confirmatory test in patients with suspected CES to rule out neurological impairment of the bladder function.

METHODS

A retrospective study was conducted on all patients who were referred to our institution with equivocal findings of cauda equina syndrome from January 2014 to December 2018 with positive MRI findings. An algorithm using multichannel UDS was followed in all the included patients.

RESULTS

Out of 249 patients who fulfilled the inclusion criteria, 34 patients (13.65%) had normal uroflowmetry and USG-PVR findings; 211 patients underwent the invasive UDS. Only 141(57.6%) patients out of 245 patients had neurovesical involvement due to compression of cauda equina; 67 patients were treated conservatively using the objective protocol. Only one patient treated conservatively had to undergo emergency decompression for deterioration in symptoms.

CONCLUSIONS

Multichannel UDS provides an objective diagnostic tool to definitively establish the neurovesical involvement in CES. Utilising multichannel UDS as an adjunct to clinical findings avoids the probability of false-positive diagnosis of CES. These slides can be retrieved under Electronic Supplementary Material.

Effects of an education program on toileting behaviors and bladder symptoms in overactive bladder patients with type 2 diabetes: A randomized clinical trial

BACKGROUND

Overactive bladder is more common in patients with type 2 diabetes than in those without diabetes. Many patients with diabetes adopt unhealthy toileting behaviors to empty their bladder that may contribute to the onset or worsening of overactive bladder.

OBJECTIVE

To investigate whether an education program targeting toileting behaviors is effective for helping overactive bladder patients with type 2 diabetes in terms of adopting healthy toileting behaviors, improving bladder symptoms, and enhancing quality of life.

DESIGN

The study was a parallel, pragmatic, open-label randomized trial.

SETTINGS

The trial was conducted in a hospital-based endocrinology outpatient department in Jinan, China.

PARTICIPANTS

A total of 104 patients were randomly assigned to a 6-week education program or a control group.

METHODS

Primary outcomes included toileting behaviors and bladder symptoms, including dry/wet overactive bladder and severity of urgency. Secondary outcomes were overactive bladder-specific and general quality of life. The patients were reassessed on the outcome variables at the end of the intervention and at 3 months and 6 months following the intervention. The analysis followed the intent-to-treat principle. To account for the longitudinal data with repeated measures, group comparisons for continuous outcomes were evaluated using linear mixed models. Group differences in binary outcomes were examined using mixed-effects logit models.

RESULTS

Compared with the control group, the education program group showed significant changes in three unhealthy toileting behaviors: premature voiding (-0.7, p < 0.001), place preference for voiding (-0.5, p = 0.007), and delayed voiding (-0.2, p = 0.011). The program significantly relieved the bladder symptoms (-2.2, p < 0.001) and decreased the probability of having wet overactive bladder (-0.3, p < 0.001) and the severity of urgency (-0.4, p < 0.001). It also significantly improved the overactive bladder-specific quality of life by 10.8 points (p = 0.001). Regarding patients' general quality of life, the physical aspect was enhanced by 3.0 points (p = 0.049); however, no effect on the mental well-being aspect was observed.

CONCLUSIONS

Among overactive bladder patients with type 2 diabetes, the 6-week education program targeting toileting behaviors resulted in the adoption of healthy toileting behaviors, relief of bladder symptoms and improvement in quality of life in the 6 months following the intervention compared with routine care alone. The education program was highly successful and may represent an effective, acceptable, feasible, and safe intervention for improving bladder health and quality of life during diabetes care, given that the toileting behavioral changes were maintained during the 6-month follow-up period.

Treatment satisfaction and bothersome bladder, bowel, sexual symptoms in multiple sclerosis

BACKGROUND

Bladder, bowel, and sexual symptoms are common among persons with multiple sclerosis (MS). We aimed to investigate the frequency and severity of bladder, bowel, and sexual symptoms, the relationships between these symptoms, satisfaction with treatment of these symptoms, and factors associated with symptom severity and treatment satisfaction.

METHODS

In the fall 2010, we surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding the severity of being bothered by bladder, bowel, and sexual symptoms, their satisfaction of health providers' inquiry and treatment with these symptoms, and whether their quality of life (QOL) had changed with the treatment. Logistic regression was used to evaluate demographic and clinical factors associated with each outcome.

RESULTS

Of 9341 respondents included in the study, 7720 (77.4%) were female and their mean (SD) age was 50.3 (10.5) years. Ninety-one percent of participants were mildly, moderately or severely bothered by bladder, bowel or sexual symptoms. Severity of disability (measured using the Patient Determined Disease Steps), having a relapse in the last 6 months, and catheter use were consistently associated with being bothered (versus not bothered) by each of the three symptoms. Among respondents, 5764 (62.1%) reported that their MS health providers asked about bladder problems, 4523 (51.1%) about bowel problems, and 1890 (20.6%) about sexual problems. At most one-third of participants were completely satisfied with treatment for any of the symptoms. For those who reported how their QOL changed with treatment, 23.0% reported their QOL being better.

CONCLUSION

Bladder, bowel, and sexual problems remain common among persons with MS, and treatment satisfaction is low. Health care providers should consider systematically asking about these symptoms in clinical practice. Greater efforts could be devoted to developing novel, effective therapies to manage these symptoms and thereby improve QOL.