Discrepancies between urinary symptoms assessment and objective bladder dysfunctions in multiple sclerosis

Abstract

Objective: To assess the association between objective bladder function parameters in relation to urinary symptoms, and to analyze the sensitivity and specificity of subjective urinary symptom-assessment in predicting objective bladder dysfunction in a multiple sclerosis (MS) population. Methods: Consecutive MS patients with Expanded Disability Status Score (EDSS) ≤7.0 were included in this prospective study. In a single visit, patients were evaluated for the presence of urinary symptoms, then assessed for the following urological parameters: maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and detrusor sphincter dyssinergia (DSD). Results: One hundred nine subjects were included with a mean disease duration of 12.5 ± 8.7 years, 90.8% had a relapsing-remitting course; the mean EDSS score was 2.6 ± 1.7. Overall, 53.5% complained of at least one urinary symptom, and the most reported one was urgency (40.7%), followed by frequency (15.7%) and incomplete emptying (12.0%). Abnormal values were found for Qmax in 34.9%, for PVR in 40.4% of participants; DSD was diagnosed in 33.9% of the cases. Only Qmax was found negatively associated with the EDSS score (p = 0.007), but no other association was observed. The presence of urinary symptoms was poor predictor of bladder dysfunction, urgency among the others showed relatively higher predicting value. Conclusions: Subjective urinary symptoms assessment failed in predicting bladder function. Our results confirmed the value of objective urological assessment in patients with MS, irrespective of the presence of urinary symptoms.

Neurourological assessment in people with multiple sclerosis (MS): a new evaluated algorithm

“…There was no statistically significant correlation between the complaints of NLUTD reported by patients with MS and the results of urodynamic examinations. This conclusion is confirmed by some other authors (Amundsen et al, 1999;Wiedemann et al, 2013;Haggiag et al, 2017;Fragalà et al, 2015). Blaivas found that a treatment based exclusively on reported symptoms was ineffective for at least 50% of patients with MS (Blaivas, 1980).…”

Use of a symptom-based questionnaire to screen for the presence of significant voiding dysfunction in patients with multiple sclerosis and lower urinary tract symptoms: a pilot study

“…The limitations of our study are the relatively small number of individuals who underwent assessment, but the demographic characteristics of our patient population was within the range of the previously reported studies [8][9][10]12]. Patients were also taken from those referred to a tertiary uroneurology service, so may have more severe LUT symptoms than the overall population of patients with MS.…”

“…Furthermore, as the bladder/bowel FSS only ranges from 0–3, it does not sufficiently delineate the severity nor fully encapsulate the nature of symptoms. Severity of LUT symptoms as assessed by unstructured interview also did not predict objective measures of LUT dysfunction including PVR, Qmax and the presence of detrusor-sphincter dyssynergia [ 12 ].…”

Aktuelles zu neurogenen Dysfunktionen des unteren Harntraktes bei Multipler Sklerose

“…Nach Haggiag et al. taugt die nichtstandardisierte Miktionsfrequenz mit einer Sensitivität von nur 26,3 % nicht als Prädiktor einer gestörten Harnblasenfunktion [ 14 ]. Die standardisierte Miktionsfrequenz korrelierte in unserer Studie gut mit einer Detrusorüberaktivität (OR = 1,16; KI:[1,07–2,06]), sodass „first-line“ eine orale oder transdermale detrusordämpfende Therapie mit Antimuskarinika gerechtfertigt ist (Tab.…”