Friday, 18 December 2015

Looking for Bladder Problems

Ghezzi A, Mutta E, Bianchi F, Bonavita S, Buttari F, Caramma A, Cavarretta R, Centonze D, Coghe GC, Coniglio G, Del Carro U, Ferrò MT, Marrosu MG, Patti F, Rovaris M, Sparaco M, Simone I, Tortorella C, Bergamaschi R.Diagnostic tools for assessment of urinary dysfunction in MS patients without urinary disturbances. Neurol Sci. 2015. [Epub ahead of print]

Many guidelines are available for the management of lower urinary tract symptoms (LUTSs) in multiple sclerosis (MS) patients, but no agreement exists on the best approach for subjects without LUTSs. The objective of this study was to evaluate whether LUTSs can be detected in MS patients asymptomatic for urinary dysfunction, comparing three different tools [measure of post-void residual volume (PRV), bladder diary (BD), a focused questionnaire (IPSS)], and whether disability, disease duration and signs of pyramidal involvement are linked to their subclinical presence. 178 MS patients (118 women) have been included (mean age 41.2 years, mean disease duration 11.3 years, mean EDSS 2.2), and tested with the above-mentioned tools. PRV was abnormal in 14 subjects (7.8 %), associated to abnormal findings at IPSS in 3 cases, at BD in 2 cases, at both in 1. BD was abnormal in 37 subjects (20.8 %), with concomitant abnormal PRV in 2, abnormal IPSS in 10 cases, abnormal IPSS and BD in 1. IPSS was ≥ 9 in 43 subjects (24.1 %). At least one test was abnormal in 76 patients (42.7 %): 1 in 57 patients (32.0 %), 2 in 17 (9.5 %), and 3 tests in 2 (1.1 %). Patients with at least one abnormal urinary variable, compared to patients without urinary abnormalities, had a more frequent pyramidal (motor tracts in the spinal column) involvement (69.5 vs. 16.8 %, p < 0.00001), a more frequent occurrence of EDSS ≥2 (83.1 vs. 23.5 %, p < 0.00001), and a longer disease duration (15.7 ± 7.3 vs. 9.1 ± 7.1, p < 0.00001). Asymptomatic LUTS were frequent but none of the tests used permitted to better identify asymptomatic patients.


You can read the conclusions

Neurogenic lower urinary tract dysfunction in the early disease phase of paediatric multiple sclerosis.Scheepe JR, Wong YY, van Pelt ED, Ketelslegers IA, Catsman-Berrevoets CE, van den Hoek J, Hintzen RQ, Neuteboom RF.Mult Scler. 2015. pii: 1352458515618541. [Epub ahead of print]


Neurogenic lower urinary tract dysfunction (LUTD) in multiple sclerosis (MS) is highly prevalent in adults, but has not previously been described in paediatric MS. A total of 24 consecutive children with newly diagnosed MS were prospectively assessed for bladder and bowel problems early after diagnosis. Five of 24 children (21%) showed LUTD during assessment. One of these patients did not report voiding complaints. This high prevalence of LUTD indicates that all recently diagnosed patients with paediatric MS should be evaluated early in their disease and treated for urinary problems in order to prevent potential damage to the upper urinary tract.

As ProfG had been saying that bladder problems can be one of the common features of MS because it is at the end of long nerves and it needs fine co-ordination to work.

2 comments:

  1. What is normal bladder function? I had a very bashful bladder since 12 or 13. After diagnosis on Tysabri for 14 months now, bladder is now less bashful.

    ReplyDelete
  2. When I was a child I had urgency problems. I was humiliated by teachers in infants school, followed by getting a letter from my GP to leave the exam room during my O'levels. I was always clumsy. Strange thing when I was diagnosed the bladder issues went away. Many years later I had a botched unnecessary surgery and the urgency returned. Makes me think I was born with MS, something I'd never thought of before.

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.