Multiple sclerosis and urinary voiding symptoms. A dedicated voiding score.

Helou E1, Hassan T1, Mouawad C1, Naoum E1, Zalaet J1, Helou J1, Abboud H1, Nemr E1, Koussa S1

Research Type


Abstract Category


Abstract 476
Neurogenic Bladder and Pediatrics
Scientific Podium Short Oral Session 26
Friday 31st August 2018
09:22 - 09:30
Hall C
Multiple Sclerosis Voiding Dysfunction Questionnaire
1. Faculty of Medecine, Saint Joseph University, Beirut, Lebanon

Elie Helou



Hypothesis / aims of study
Multiple sclerosis (MS) patients develop lower urinary tract symptoms (LUTS) during the progression of their disease. Disease severity and urinary filling symptoms can be assessed through many validated scores like EDSS and OABSS (1). The scarcity of dedicated voiding symptom scores in the neurological population has led us to screen and test the correlation between urinary voiding symptoms and the disability score in MS patients. The aim of this study is to assess the possibility of establishing a new voiding symptom score correlating to the patients’ disability.
Study design, materials and methods
40 patients with MS and LUTS were recruited between July and November 2017. Patients who have other causes for their urinary symptoms such as benign prostatic hypertrophy, urethral stenosis, bladder cancer, prostate cancer or a history of urological surgeries were excluded from the study. Information on disability (using EDSS : Expanded Disability Status Scale) and all voiding LUTS (using a scoring system similar to that of IPSS: International Prostate Symptom Score) was gathered through questionnaires during personal interviews. Correlation was studied using bivariate correlation test to measure the linear relation between variables.
40 Patients were equally divided between genders, with an age of 43 ± 10 years, a mean MS duration of 11.6 ± 8 years and mean duration of urinary symptoms of 6.4 ± 6 years. Mean EDSS was 3.9 ± 2. EDSS had a moderate positive correlation with straining (r=0.34), intermittency (r=0.26) and slow stream (r=0.25), in that order, while having a weak positive correlation with terminal dribble (r=0.198), hesitancy (r=0.127), and feeling of incomplete emptying (r=0.12), in that order. The positive correlation with straining was the only significant one (p=0.03). After combining the first three symptoms in the IPSS-3V score, there was also a moderately positive correlation with EDSS (r=0.393) that was statistically significant (p=0.01).
Interpretation of results
The average EDSS in our study was lower than what is usually found in other studies on MS mainly because many patients came from distant regions which might have encouraged more independent subjects to participate in this study. All voiding symptoms showed positive correlation with EDSS, however it wasn’t a strong correlation and, in most cases, not significant. Straining showed the strongest correlation as an individual voiding symptom and it was statistically significant. The three voiding symptoms combined in the IPSS-3V (straining, intermittency and slow stream) correlated the most with the severity of MS, showing that MS progression affects mainly these three symptoms. The IPSS-3V showed a stronger significant correlation than that of any individual voiding symptom. No previous studies has shown such a correlation with a specific set of voiding symptoms.
Concluding message
MS progression affects all voiding LUTS to different extents. The severity of voiding LUTS increases with disease progression, especially straining. The combination of straining, intermittency and slow stream in a new score IPSS-3V seems to be a promising index for voiding LUTS severity in MS patients. No previous studies have shown such a correlation between MS severity and a dedicated voiding score.
Figure 1
  1. Akkoç Y, Ersöz M, Yüceyar N, Tunç H, Köklü K, Yoldas TK, Dönmez Ü, Uzunköprü C, Alemdaroglu E, Bilen S, Emre U, Özdolap S, Tuncay E, Yücesan C, Gök H, Ercan MB, Uygunol K, Koçer B, Zinnuroglu M; Neurogenic Bladder Turkish Research Group. Overactive bladder symptoms in patients with multiple sclerosis: Frequency, severity, diagnosis and treatment. J Spinal Cord Med. 2016;39(2):229-33.
Funding Saint Joseph University, Beirut, Lebanon Clinical Trial No Subjects Human Ethics Committee Comite d'ethique de l'universite saint joseph Helsinki Yes Informed Consent Yes