Evaluation of lower urinary tract symptoms in multiple sclerosis patients: Review of the literature and current guidelines

Abstract

Multiple sclerosis (MS) is a unique neurological disease with a broad spectrum of clinical presentations that are time-and disease course-related. MS plaque location (intracranial and/or spinal) is a key feature in the pathophysiology of disease-related lower urinary tract symptoms (LUTS). The prevalence of these symptoms in MS patients is very high, with nearly 90% of them experiencing some degree of voiding dysfunction and/or incontinence. LUTS rarely present as primary MS manifestations and usually appear 6-8 years after the initial diagnosis. Symptom severity usually correlates with the disability status of patients.Patient assessment comprises clinical and advanced investigations. Each patient should be evaluated uniquely, after taking into account his/her symptoms, disease course and length, comorbidities, physical status, and medications. Basic investigation includes detailed history-taking, physical examination, and post-void residual volume measurement. Advanced evaluation consists of imaging and specific testing, with pivotal importance on urodynamic study.

The prevalence of lower urinary tract symptoms based on individual and clinical parameters in patients with multiple sclerosis

“…The symptomatology of MS ranges widely according to the location of lesions in the CNS [27]. MS plaque location is a key feature in the pathophysiology of disease-related LUTS [28]. The unstable pattern and location of the demyelination area along with the associated edema are responsible for the alteration in both the neurologic and urologic features of MS.…”

“…Moreover, a review study revealed that LUTS were common among patients with MS and 80-100% of patients suffer from LUTS during the course of MS. [32] In the present study, the highest rates of LUTS reported among all of the subjects were related to nocturia, urgency, diurnal polyuria, and feeling of incomplete urine emptying, respectively. A study on 9700 patients with MS revealed that nocturia and urgency were the first and second most prevalent LUTS in these patients [28]. In a study, the incidence of polyuria, straining, nocturnal polyuria, urgency, urinary incontinence, urinary discontinuation, and feeling of incomplete urine emptying among patients with MS was reported to be 61.9, 50.0, 47.6, 47.6, 38.0, 30.9, and 28.5%, respectively [33].…”

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

“…First, the modality of data collection of urinary symptoms may be questionable. Although our choice to adopt an unstructured interview for the collection of major urinary symptoms was intended to reproduce clinical routine practice, the use of validated questionnaires would have allowed a more homogenous and reliable assessment [14]. Second, the selection of the objective urological parameters adopted in our study may be questionable as compared to more reliable and invasive diagnostic procedures, such as simultaneous recording of intravesical pressure and needle sphincter electromyography [12].…”

The Prevalence of Lower Urinary Tract Symptoms Based on Individual and Clinical Parameters in Patients with Multiple Sclerosis

“…The mean body mass index (BMI) of the patients with mild, moderate, and severe LUTS was 24.22 ± 4.25, 24.31 ± 4.51, and 23.93 ± 4.16 Kg/m 2 , respectively, and ANOVA showed no significant difference among LUTS severity groups in terms of BMI (P = 0.670). The prevalence of mild, moderate, and severe LUTS was, respectively, 44.3%, 33.8%, and 6.7% among women and 39.1%, 28.9%, and 14.8% among men, and the chi-square test indicated a significant difference between the two groups (P = 0.024). This rate was 40.9%, 29.6%, and 8.7% among single individuals, 45.1%, 33.0%, and 7.4% among married subjects, and 31.6%, 42.1%, and 18.4% among divorced and dead subjects, respectively, and the chi-square test showed significant differences among the three groups (P = 0.051).…”