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

Abstract

Introduction Lower urinary tract dysfunction is common in people with multiple sclerosis, leading to overactive bladder symptoms, voiding difficulties or a combination. First-line medications for overactive bladder symptoms are effective. Current guidelines recommend measuring post-void residual volume (PVR) before commencing these treatments, as they can potentially exacerbate voiding difficulties in those with significant underlying voiding dysfunction (pre-treatment PVR > 100 ml). However, facilities to do so are not readily available to all clinicians, potentially delaying effective therapy. Aims To conduct a pilot study investigating the association between lower urinary tract symptoms and PVR volume in people with multiple sclerosis using a validated questionnaire and to determine if questionnaire scores can be used to exclude a significantly elevated (> 100 ml) PVR volume. Methods Patients with multiple sclerosis referred to a tertiary hospital uro-neurology service completed the Urinary Symptom Profile questionnaire and underwent PVR measurement by bladder ultrasound. A ratio of the questionnaire low stream score/total score was calculated to standardise the relative degree of voiding symptoms compared to overall lower urinary tract symptoms. Results Of 40 patients (29 females, mean age 50 years), 30% had an elevated PVR volume. PVR volume was correlated with low stream score and ratio of low stream/total score. A cutoff of > 0.15 for low stream/total score ratio had 92% sensitivity and 71% specificity in predicting an elevated PVR volume. Conclusion A symptom-based questionnaire maybe a useful screening tool to distinguish patients in whom PVR measurement is required from those who could safely start on treatment for overactive bladder symptoms.

Dehydration associates with lower urinary tract symptoms in progressive multiple sclerosis

“…We aimed to use questions from a published questionnaire to assess LUTS, but this was not validated for pwMS; and while urgency and urge incontinence were used as indicators of bladder overactivity, the questionnaire did not cover the symptoms of nocturia and frequency [19]. It might have been better to use questionnaires which have been validated in patients with neurogenic bladder such as the Neurogenic Bladder Symptom Score [28], the Urinary Symptom Questionnaire [29] or the Urinary Symptom Profile [30,31]. LUTS can also occur secondary to other pathologies, such as benign prostatic hyperplasia, and participants were not screened for this and other urological conditions.…”