Urinary dysfunction in women with multiple sclerosis: analysis of 61 patients from Rio de Janeiro, Brazil

Abstract

The aim of the present study is to describe the type and frequency of bladder dysfunction in a series of female patients with multiple sclerosis (MS) from Rio de Janeiro, and analyze the role of the urologist in the multidisciplinary team. A team of urologists and a neurologist from the Hospital da Lagoa, Rio de Janeiro, Brazil, interviewed female patients with MS about illness onset, urologic follow-up since diagnosis, current stage of the disease and current urological symptoms. The interview was followed by an urodynamic testing, ultrasound of the urinary tract and urinalysis. Data resulting from the interviews and exam results were gathered and submitted to statistical evaluation. Sixty one patients were evaluated, with average age of 41.4 years. Urinary symptoms such as urinary incontinence, urinary hesitancy, urinary retention, urinary urgency and incomplete bladder emptying were reported in 44% of patients as initial signs of MS disease. Mean disease duration was 8 years and all patients (100%) with the primary progressive form of the disease and 63.5% with the relapsingremitting presentation had urological symptoms. Analysis of complementary exams showed that 37.7% of urinalysis, 8.2% of the urinary tract ultrasound exams and 66.7% of the urodynamic evaluations were abnormal and the most frequent abnormality were overactive neurogenic bladder. Only 4 patients (6.6%) had seen an urologist during the course of their disease and only 1.6% had performed an urodynamic evaluation. This study shows a high prevalence (68%) of urinary dysfunction in a female population with MS. Urologic care should be part of the multidisciplinary team since the beginning of the disease. An urodynamic evaluation and simple urinalysis should be included in the routine testing during disease follow-up due to the high incidence of neurogenic bladder and other urologic complications.

Evaluation of Quality of Life among Patients with Multiple Sclerosis and Lower Urinary Tract Symptoms: A Cross-Sectional Study

“…The results of a study in Brazil showed a weak significant relationship between the duration of the disease and the presence of urinary dysfunction, and the degree of urinary dysfunction increased over the years. [43] In another study, the duration of disease and higher degree of disability only had a significant relationship with higher levels of urinary symptoms in women. [13] The review of data from the American Research Committee on Multiple Sclerosis (NARCOMS) showed that, with an increase in the duration of disease, the severity and prevalence of LUTS increased, so that on average 35-39% of patients 5-6 years after the onset of the disease, and in contrast, 64% of patients with a 17.1 year history of disease reported LUTS.…”

“…[44] The current study revealed that the prevalence of LUTS was higher in patients with CIS; however, the prevalence of mixed LUTS in patients with progressive MS was higher in comparison to patients with MS with RRMS and CIS, and the difference was statistically significant. De Almedia reported prevalence rates of 63.5% and 100%, respectively, among patients with RRMS and primary progressive MS. [43] Moreover, a study by Wang et al showed the lowest OBASS score in patients with CIS. [23] In the present study, patients with MS and LUTS symptoms compared to LUTS-free patients had lower QOL scores in all dimensions except for health changes and there was a significant difference in the combined physical and mental health dimensions of QOL between the two groups with and without LUTS.…”

Evaluation of Quality of Life among Patients with Multiple Sclerosis and voiding dysfunction: A Cross-Sectional Study

“…The results of a study in Brazil showed a weak significant relationship between the duration of the disease and the presence of urinary dysfunction, and the degree of urinary dysfunction increased over the years. [48] In another study, the duration of disease and higher degree of disability only had a significant relationship with higher levels of urinary symptoms in women. [14] The review of data from the American Research Committee on Multiple Sclerosis (NARCOMS) showed that, with an increase in the duration of disease, the severity and prevalence of LUTS increased, so that on average 35-39% of patients 5-6 years after the onset of the disease, and in contrast, 64% of patients with a 17.1 year history of disease reported LUTS.…”

“…[49] The current study revealed that the prevalence of LUTS was higher in patients with CIS; however, the prevalence of mixed LUTS in patients with progressive MS was higher in comparison to patients with MS with RRMS and CIS, and the difference was statistically significant. De Almedia reported prevalence rates of 63.5% and 100%, respectively, among patients with RRMS and primary progressive MS. [48] Moreover, a study by Wang et al showed the lowest OBASS score in patients with CIS. [29] In the present study, patients with MS and LUTS symptoms compared to LUTS-free patients had lower QOL scores in all dimensions except for health changes and there was a significant difference in the combined physical and mental health dimensions of QOL between the two groups with and without LUTS.…”

Vigorous cool room treadmill training to improve walking ability in people with multiple sclerosis who use ambulatory assistive devices: a feasibility study

“…Lastly, we were unable to complete blood draws in some subjects, and it appeared that hypo-hydration could have been a factor. Although we did not determine whether participants had bladder problems, about 80 to 100% of people with progressive MS have bladder insufficiency [101,102]. Future trials should consider the issue of hydration during exercise.…”