Clinical Predictors of Neurogenic Lower Urinary Tract Dysfunction in Persons with Multiple Sclerosis

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.

Neurogenic Lower Urinary Tract Dysfunction in Asymptomatic Patients with Multiple Sclerosis

“…The correlation between the different clinical parameters and the pathological UDS indicative of NLUTD was assessed. The UDS findings indicative of NLUTD were defined by us, according to current doctrine [ 15 ] and according to a previous investigation [ 16 ]: first desire to void <100 mL, strong desire to void <250 mL, abnormal sensation or bladder capacity < 250 mL, bladder compliance < 20 mL/cm H 2 O, or any type of DO or DSD.…”

“…The clinical parameters and the thresholds were defined according to the results of a previous investigation [ 16 ] as follows, and MVP were additionally analyzed: Voided volume from bladder diary (VVBD) ≤250 mL or ≥500 mL Voided volume from uroflowmetry (VVUF) ≥500 mL Minimal voided portion (MinVP) ≤50 mL Maximal voided portion (MaxVP) ≥500 mL Urinary tract infection (UTI) rate >0/6 month 24 h standardized voiding frequency (SVF) ≤4 or ≥13 Post-voided residual (PVR) >100 mL Uroflowmetry (UF) abnormal curve or PVR > 100 mL or max flow rate < 10 mL/s …”

Editorial of Special Issue “Multiple Sclerosis: From Diagnostic Biomarkers to Imaging and Clinical Predictors”

“…Based on these findings, MS rehabilitation studies should account for the high kinesiophobia rate in more-disabled MS patients, which could significantly influence the recruitment rate and persistence in the program. Beck et al performed undynamic studies in 207 MS patients and showcased that the majority (83%) of patients had pathological outcomes indicative of neurogenic lower urinary tract dysfunction [ 10 ]. The urodynamic pathology was not dependent on the physical disability of the MS patients [ 10 ].…”

“…Beck et al performed undynamic studies in 207 MS patients and showcased that the majority (83%) of patients had pathological outcomes indicative of neurogenic lower urinary tract dysfunction [ 10 ]. The urodynamic pathology was not dependent on the physical disability of the MS patients [ 10 ]. The presence of post-void residual, less than 250 mL voided volume and presence of urinary tract infection in the past 6 months were all associated with neurogenic lower urinary tract dysfunction [ 10 ].…”

“…The urodynamic pathology was not dependent on the physical disability of the MS patients [ 10 ]. The presence of post-void residual, less than 250 mL voided volume and presence of urinary tract infection in the past 6 months were all associated with neurogenic lower urinary tract dysfunction [ 10 ].…”