Wiedemann A et al. Which clinical risk factors determine a pathological urodynamic evaluation in patients with multiple sclerosis? an analysis of 100 prospective cases.World J Urol. 2012 Jan 7. [Epub ahead of print]
BACKGROUND:Urinary tract symptoms are an underestimated problem in multiple sclerosis (MS).
OBJECTIVE:Hundred urodynamics of MS patients have been evaluated prospectively.
DESIGN, SETTING AND PARTICIPANTS:In an inpatient rehabilitation, all persons with MS who also suffered from urinary tract symptoms received a voiding diary, post-void sonography and an urodynamic examination according to International Continence-Society-Standard.
RESULTS AND LIMITATIONS:Between 10/2009 and 3/2011, 100 patients (79 women; 21 men; mean EDSS, 4.52 ± 2.26) were examined who had primary progressive MS (9×), relapsing-remitting MS (41×), secondary progressive MS (43×) and Clinically Isolated syndrome (1×). The mean duration of MS was 10.26 ± 10.09 years and mean duration of lower urinaray tract syndrone, 6.9 ± 7.75 years. Urodynamic testing showed normal findings in 22 patients, detrusor (muscle that contracts to empty the bladder. Imagine a balloon and you use you hand to squeeze the balloon whilst holding the neck. see below the bloke jumping on the top) overactivity in 7, increased bladder sensation without detrusor overactivity in 21, detrusor-sphincter (the sphincter controls the opening of the bladder this has to relax to open the urethra and then the detrusor contracts to empty the bladder) dyssynergia (not-co-ordinated) in 26, detrusor hypocontractility (detrusor contracts less than normal) in 12, detrusor acontractility (derusor does not contract) in 4 and unclear diagnosis in 8 patients. Statistically significant risk factors for pathological urodynamic findings were as follows: wheelchair dependency, use of more than one incontinence pad per day and a MS type other than relapsing-remitting.
CONCLUSIONS:The urodynamic investigation at hand showed urinary tract dysfunction in 78 of 100 MS patients with lower urinary tract symptoms. The long latency (time difference) between the occurrence of MS and/or the beginning of lower urinary tract symptoms (bladder problems) and the first neuro-urological evaluation (time when neuro or urologists takes note of the problem) indicates a deficit in treatment. Beyond national guidelines, all MS patients should at regular intervals be questioned about LUTS and receive urodynamic assessment especially according to the presented risk profile.
Incontinence is one of the more embasassing symptoms of MS, that can really impact on your activity. Make sure you talk with your neuro if you feel that anything is not quite the same as it was.