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Abstract

Background:

Neurogenic lower urinary tract dysfunction (NLUTD) is very common in patients with multiple sclerosis (MS), and it might jeopardize renal function and thereby increase mortality. Although there are well-known urodynamic risk factors for upper urinary tract damage, no clinical prediction parameters are available.

Objective:

We aimed to assess clinical parameters potentially predicting urodynamic risk factors for upper urinary tract damage.

Methods:

A consecutive series of 141 patients with MS referred from neurologists for primary neuro-urological work-up including urodynamics were prospectively evaluated. Clinical parameters taken into account were age, sex, duration, and clinical course of MS and Expanded Disability Status Scale (EDSS).

Results:

Multivariate modeling revealed EDSS as a clinical parameter significantly associated with urodynamic risk factors for upper urinary tract damage (odds ratio = 1.34, 95% confidence interval (CI) = 1.06–1.71, p = 0.02). Using receiver operator characteristic (ROC) curves, an EDSS of 5.0 as cutoff showed a sensitivity of 86%–87% and a specificity of 52% for at least one urodynamic risk factor for upper urinary tract damage.

Conclusion:

High EDSS is significantly associated with urodynamic risk factors for upper urinary tract damage and allows a risk-dependent stratification in daily neurological clinical practice to identify MS patients requiring further neuro-urological assessment and treatment.

Keywords

Multiple sclerosis (MS)Expanded Disability Status Scale (EDSS)prospective study neuro-urology neurogenic lower urinary tract dysfunction (NLUTD)overactive bladder detrusor sphincter dyssynergia (DSD)vesico-uretero-renal reflux

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References

Panicker

Fowler

Kessler

TM.

Lower urinary tract dysfunction in the neurological patient: Clinical assessment and management. Lancet Neurol 2015; 14: 720–732.

Groen

Pannek

Castro Diaz

et al . Summary of European Association of Urology (EAU) guidelines on neuro-urology. Eur Urol 2016; 69: 324–333.

Koldewijn

Hommes

Lemmens

et al . Relationship between lower urinary tract abnormalities and disease-related parameters in multiple sclerosis. J Urol 1995; 154: 169–173.

Litwiller

Frohman

Zimmern

PE.

Multiple sclerosis and the urologist. J Urol 1999; 161: 743–757.

De Seze

Ruffion

Denys

et al . The neurogenic bladder in multiple sclerosis: Review of the literature and proposal of management guidelines. Mult Scler 2007; 13: 915–928.

Abrams

Cardozo

Fall

et al . The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 167–178.

Hinson

Boone

TB.

Urodynamics and multiple sclerosis. Urol Clin North Am 1996; 23: 475–481.

Stöhrer

Blok

Castro-Diaz

et al . EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol 2009; 56: 81–88.

Wiedemann

Kaeder

Greulich

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 2013; 31: 229–233.

10.

Giannantoni

Scivoletto

Di Stasi

et al . Urological dysfunctions and upper urinary tract involvement in multiple sclerosis patients. Neurourol Urodyn 1998; 17: 89–98.

11.

Fowler

Panicker

Drake

et al . A UK consensus on the management of the bladder in multiple sclerosis. Postgrad Med J 2009; 85: 552–559.

12.

Ghezzi

Carone

Del Popolo

et al . Recommendations for the management of urinary disorders in multiple sclerosis: A consensus of the Italian Multiple Sclerosis Study Group. Neurol Sci 2011; 32: 1223–1231.

13.

Amarenco

Chartier-Kastler

Denys

et al . First-line urological evaluation in multiple sclerosis: Validation of a specific decision-making algorithm. Mult Scler 2013; 19: 1931–1937.

14.

Kurtzke

JF.

Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 1983; 33: 1444–1452.

15.

Gammie

Clarkson

Constantinou

et al . International Continence Society guidelines on urodynamic equipment performance. Neurourol Urodyn 2014; 33: 370–379.

16.

Hackler

Hall

Zampieri

TA.

Bladder hypocompliance in the spinal cord injury population. J Urol 1989; 141: 1390–1393.

17.

McGuire

Woodside

Borden

et al . Prognostic value of urodynamic testing in myelodysplastic patients. J Urol 1981; 126: 205–209.

18.

Ontaneda

Fox

Chataway

Clinical trials in progressive multiple sclerosis: Lessons learned and future perspectives. Lancet Neurol 2015; 14: 208–223.

19.

DeLong

Clarke-Pearson

DL.

Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics 1988; 44: 837–845.

20.

Team

RC.

R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing, 2015, https://www.R-project.org

21.

Lawrenson

Wyndaele

Vlachonikolis

et al . Renal failure in patients with neurogenic lower urinary tract dysfunction. Neuroepidemiology 2001; 20: 138–143.

22.

Viart

Elalouf

Petit

et al . [Prognostics factors of renal failure in multiple sclerosis]. Progres en urologie: journal de l’Association francaise d’urologie et de la Societe francaise d’urologie 2012; 22: 1026–1032.

23.

Samellas

Rubin

Management of upper urinary tract complications in multiple sclerosis by means of urinary diversion to an ideal conduit. J Urol 1965; 93: 548–552.

24.

Cetinel

Tarcan

Demirkesen

et al . Management of lower urinary tract dysfunction in multiple sclerosis: A systematic review and Turkish consensus report. Neurourol Urodyn 2013; 32: 1047–1057.

25.

Giannantoni

Scivoletto

Di Stasi

et al . Lower urinary tract dysfunction and disability status in patients with multiple sclerosis. Arch Phys Med Rehabil 1999; 80: 437–441.

26.

Gallien

Robineau

Nicolas

et al . Vesicourethral dysfunction and urodynamic findings in multiple sclerosis: A study of 149 cases. Arch Phys Med Rehabil 1998; 79: 255–257.

27.

Ginsberg

The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care 2013; 19: s191–s196.

28.

Miller

Simpson

Yeates

WK.

Bladder dysfunction in multiple sclerosis. Brit Med J 1965; 1: 1265–1269.

29.

Ritter

Grabner

[Cystometric examination of the multiple sclerosis patient]. Deutsche medizinische Wochenschrift 1946; 1968(93): 1942–1946.

30.

Anderson

Bradley

WE.

Bladder and urethral innervation in multiple sclerosis. Brit J Urol 1976; 48: 239–243.

31.

Bradley

WE.

Urinary bladder dysfunction in multiple sclerosis. Neurology 1978; 28: 52–58.

32.

Philp

Read

Higson

RH.

The urodynamic characteristics of multiple sclerosis. Brit J Urol 1981; 53: 672–675.

33.

Awad

Gajewski

Sogbein

et al . Relationship between neurological and urological status in patients with multiple sclerosis. J Urol 1984; 132: 499–502.

34.

Betts

D’Mellow

Fowler

CJ.

Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis. J Neurol Neurosurg Psychiatry 1993; 56: 245–250.

35.

Nakipoglu

Kaya

Orhan

et al . Urinary dysfunction in multiple sclerosis. J Clin Neurosci 2009; 16: 1321–1324.

High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Keywords

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References