Vesicourethral Dysfunction and Urodynamic Findings in Multiple Sclerosis: A Study of 149 Cases

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

“…Urgency resulted as the most predictive symptom, albeit modestly. Our data, in line with previous studies [5,13], suggest that in patients with MS objective bladder evaluation, irrespective of subjective urinary symptoms, may contribute to a more complete and reliable assessment of patient's disability. Given the feasibility of these non-invasive urological evaluations, we recommend making that objective assessment of bladder function become standard considerations in the evaluation of patients with MS, regardless of the presence of subjective urinary symptoms.…”

“…This agrees with the findings of a large MS population study, where subjective assessments by bladder FS score and Guy's Neurological Disability Scale bladder function score were not predictive of a clinically relevant postmicturition volume [13]. Similarly, in a prospective study of symptomatic MS patients, no significant correlation was found between clinical features and urodynamic patterns [5]. Instead, Betts et al showed that MS patients with irritative bladder symptoms and lower limb pyramidal involvement were highly likely to have detrusor hyperreflexia, such as to make unnecessary to run the urodynamic study to choose the anticholinergic therapy [7]; similarly Araki et al found that urinary irritative symptoms reflect the disease severity [9].…”

“…Few and heterogeneous studies have investigated the relationship between subjective urinary complaints and objective urological parameters in MS patients, reaching different conclusions [3,[5][6][7][8][9]. Is a routinary evaluation of urinary symptoms sufficient to exclude the presence of bladder dysfunction in patients with MS?…”

Urinary tract infections in multiple sclerosis

“…Risk factors for recurrent UTIs have been poorly studied, however it is thought that the presence of LUT dysfunction such as detrusor overactivity, detrusor sphincter dyssynergia or incomplete bladder emptying with large post-void residual volumes, the use of urinary catheters, the presence of vesicoureteric reflux, female gender and the use of immunosuppressive treatment increases the likelihood for UTIs [2], [3], [21]. Increasing functional dependence is associated with greater difficulties in toileting and personal hygiene and may increase the risk for UTIs.…”

“…However this is also likely to reflect the lack of a consensus definition or diagnostic criteria for a UTI in patients with neurological disorders such as MS [1]. In general, the likelihood of infection is greater with longer disease duration and higher EDSS score [2], [3], though UTIs may occur at any time point during the course of the disease [1]. Urinary tract infections may exacerbate MS-related lower urinary tract (LUT) symptoms such as urinary urgency, frequency and incontinence.…”