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.