Voiding dysfunction and complications in multiple sclerosis

Abello A1, Das A K1

Research Type

Clinical

Abstract Category

Neurourology

Abstract 415
Open Discussion ePosters
Scientific Open Discussion Session 21
Thursday 30th August 2018
13:20 - 13:25 (ePoster Station 11)
Exhibition Hall
Voiding Dysfunction Multiple Sclerosis Outcomes Research Methods Detrusor Overactivity Urgency/Frequency
1. Beth Israel Deaconess Medical Center
Presenter
A

Alejandro Abello

Links

Poster

Abstract

Hypothesis / aims of study
Multiple sclerosis (MS) is a progressive demyelinating disease affecting the central nervous system that is frequently related to voiding dysfunction and a wide range of urinary complications. However, urodynamic (UDS) changes in this population and other potential risk factors that predispose individuals with MS to develop complications is largely unknown. Therefore, in this observational study, we described the frequency of urologic complications in a cohort of MS patients, reported changes in UDS and aimed to identify characteristics that increase their odds to develop adverse outcomes.
Study design, materials and methods
After institutional review board approval, consecutive patients diagnosed with MS who had been followed regularly by urology with serial UDS were analyzed. Other characteristics including lower urinary tract symptoms (LUTS), expanded disability status score (EDSS), complications, creatinine and imaging were recorded at each visit. T tests or Wilcoxon for continuous variables, and Chi-square for binomial variables were used to assess statistical significance (P value <0.05). Univariable and Multivariable logistic regression were performed for independent variables.
Results
The study cohort included 107 MS patients with a mean age at diagnosis of 37. Patients were followed by Urology for a mean of 97 months (Table 1). At baseline, 73% had Relapse-Remitting (RR) subtype; mean EDSS was 3.2. LUTS were present in all participants during first visit; the most common complaints were: Incontinence (72%), urgency (71%) and incomplete emptying (58%). The 2 most frequent UDS patterns at baseline were Detrusor Overactivity (DO) + Dyssynergia (DSD) and DO alone in 32% and 20% respectively. Median bladder capacity was 286 ml, median Q max of 8 ml/s and median PVR 100 ml (Table 2). During follow-up, MS progressed in 39% and EDSS progressed to a mean of 5.6. From the entire cohort, 54% developed ≥ 1 complication. The most common complication was lower urinary tract infections (UTI).  Complicated UTIs, bladder or kidney stones, and persistent hydronephrosis were rare and presented in less than 10%. There were no cases of chronic renal failure secondary to MS during follow-up. After multivariate analysis, EDSS > 6.0 (OR 7.2, 95% CI 2.8-18; P value < 0.001) and EDSS progression >2.5 (OR 4.8, 95% CI 2.0-11.7; P value <0.001) were significantly associated with increased odds for overall urologic complications. Bladder capacity significantly decreased during follow-up but was not related to complications after multivariate analysis. No other UDS parameter or baseline characteristics reached statistical significance.
Interpretation of results
The overall frequency of severe urologic complications in MS patients over an 8-year period was low. Adverse outcomes in this population approximated the overall worsening status of the primary neurologic disease process and resultant increase in total disability during follow-up. Different UDS parameters or changes in voiding function were not related to complications.
Concluding message
While LUTS and changes in voiding function are frequent and difficult to control, these were not associated with adverse outcomes in our study population. Furthermore, serious complications like upper tract deterioration were rare in this cohort.
Figure 1
Figure 2
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Beth Israel Deaconess Medical Center Institutional Review Board Helsinki Yes Informed Consent No
27/03/2024 19:50:34