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

Abstract

Background: Neurogenic lower urinary tract dysfunction (NULTD) is common in patients with multiple sclerosis (MS); nevertheless, it is often underestimated, underdiagnosed, and undertreated due to patients' sense of shame, variability of symptoms, as well as lack of communication between neurologists and urologists, despite the availability of several guidelines based on scientific evidence and expert opinion. Objective: This study was conducted to develop an easy-to-perform algorithm for diagnosing neurogenic lower urinary tract disease in patients with MS for daily neurological and urological routine, including the identification of red flags. Methods: In consensus group meetings, interprofessional experts (neurologists, urologists, neurourologists, nurses, nurse practitioners, occupational therapists, physical therapists as well as representatives of national MS centers, self-care groups, social care, residential care, and health-aid-providers) developed a diagnostic algorithm to detect NULTD in patients with MS. Subsequently, the group evaluated the algorithm in 121 patients with MS using micturition diary, post-void residual volume, uroflowmetry, and urodynamic studies. Statistical analysis was conducted on the basis of logistic regression models to compare patients with normal and abnormal urodynamic examinations. Differentiation was performed using selected diagnostic parameters as well as standard performance measures for binary classifiers to assess prognostic quality. Results: The following four parameters allowed to diagnose NLUTD in patients with MS: post-void residual urine volume, rate of urinary tract infections during the past 6 months, micturition frequency, and incontinence. According to statistical analysis, the following thresholds could be defined: post-void residual volume (PVR) ≥70 mL (Odds Ratio (OR) = 1.24; 95% CI:[1.07,1.62]), urinary tract infection (UTI) rate -none in 6 months (OR = 2.03; 95% CI:[1.04,6.68]), and micturition frequency >13/day, standardized on 2000 mL urine

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

“…In addition to the well-known parameters PVR and rate of UTI, we found increased SVF to be indicative of NLUTD and UUTD. SVF was first assessed by Domurath et al [ 11 ] as part of a newly evaluated algorithm in the neuro-urological assessment of persons with MS. A significant correlation between DO and SVF was found with a cut off ≥ 13/24 h, 95.5% of the patients showed abnormal UDS results [ 11 ]. We assessed increased SVF as a single parameter and obtained significant correlations to UDS findings indicative of NLUTD.…”

“…The cut-off values of VV were chosen according to a preliminary analysis of our study cohort and according to good urodynamic practice [ 9 ]. The thresholds of SVF, UTI, and PVR were defined according to the results of a previous investigation [ 11 ]. Voiding frequency was standardized (SVF) to a daily urine outtake of 2000 mL.…”

“…Voiding frequency was standardized (SVF) to a daily urine outtake of 2000 mL. The following formula was used [ 11 ]: …”

Neurogenic Lower Urinary Tract Dysfunction in Asymptomatic Patients with Multiple Sclerosis

“…It has been highlighted in previous studies that a significant proportion of asymptomatic patients with MS have NLUTD [ 8 , 9 , 13 ], and this absence of symptoms is not reflected in UDS [ 10 ]. Although a high number of pathologic UDS findings in clinically asymptomatic patients with MS was described as early as in 1991 by Bemelmanns et al [ 8 ], there has been only one other specific study on this patient cohort [ 18 ].…”

“…The VF was standardized (SVF) according to a daily urine outtake of 2000 mL. The following formula was used [ 13 ]: …”