Hypothesis / aims of study
Multiple sclerosis (MS) is a neurological disease with a broad spectrum of clinical presentations. Depending on the lesion location, patients might suffer from a different set of lower urinary tract symptoms (LUTS). Some patients present with dominant filling LUTS like urgency, frequency or urge urinary incontinence, while others may suffer from voiding LUTS like slow stream, intermittency, straining and feeling of incomplete emptying. Several scales have been developed to assess the disability status of the patients, the severity of their LUTS and their urologic quality of life (QoL) but there are no studies that have identified through which urinary symptoms urologic quality of life (QoL) is mostly affected. The aim of this cross-sectional study is to evaluate for the first time how, and through which urinary symptoms, MS disability can influence urologic QoL .
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, prostate cancer, bladder cancer, urethral stenosis or a history of urological surgeries were excluded from the study. Information including the patients' EDSS (Expanded Disability Status Scale), voiding and filling LUTS, OABSS (Overactive Bladder Symptom Score), UBQMS (1) (Urinary Bothersome Questionnaire in multiple sclerosis), and urologic QoL (SF-QUALIVEEN) (2) was gathered through questionnaires during personal interviews. Correlation was studied using bivariate correlation test to measure the linear relation between variables.
Results
There was a significant positive correlation between EDSS and OABSS, OABSS and UBQMS-filling, UBQMS-filling and SF-QUALIVEEN. This positive correlation was also found between EDSS and SF-QUALIVEEN, and, OABSS and SF-QUALIVEEN. Urgency and urge urinary incontinence correlated with UBQMS-filling, but only urge urinary incontinence correlated significantly with SF-QUALIVEEN.
No voiding symptom reached significant correlation with SF-QUALIVEEN. Same for UBQMS-voiding and SF-QUALIVEEN.
Pearson correlation:
EDSS / OABSS: r= 0.448, p <0.01*
EDSS / UBQMS-filling score: r= 0.263, p=0.1
EDSS / SF-QUALIVEEN: r= 0.402, p= 0.01*
OABSS / UBQMS-filling score: r= 0.462, p <0.01*
OABSS / SF-QUALIVEEN: r= 0.324, p=0.04*
UBQMS-filling score / SF-QUALIVEEN: r=0.571, p <0.01*
Pollakiuria / UBQMS-filling score: r= 0.251, p= 0.1
Pollakiuria / SF-QUALIVEEN: r= 0.154, p= 0.3
Nycturia / UBQMS-filling score: r= 0.230, p= 0.1
Nycturia / SF-QUALIVEEN: r= 0.122, p= 0.5
Urgency / UBQMS-filling score: r= 0.358, p= 0.02*
Urgency / SF-QUALIVEEN: r= 0.155, p= 0.3
Urge urinary incontinence / UBQMS-filling score: r= 0.464, p <0.01*
Urge urinary incontinence / SF-QUALIVEEN: r= 0.478, p <0.01*
EDSS / UBQMS-voiding score: r= 0.298, p= 0.06
UBQMS-voiding score / SF-QUALIVEEN: r= 0.266, p= 0.1
Straining / SF-QUALIVEEN: r= 0.264, p= 0.1
Slow stream / SF-QUALIVEEN: r= -0.095, p= 0.6
Intermittency / SF-QUALIVEEN: r= 0.182, p= 0.3
Feeling of incomplete emptying / SF-QUALIVEEN: r= 0.040, p= 0.8
Interpretation of results
The disability due to MS is associated with more severe urinary filling symptoms, more bother due to these symptoms, and a lower urologic QoL. Urgency and specially urge urinary incontinence play the major role in urinary bother and urologic QoL.
Urologic QoL was not affected significantly by voiding symptoms and the bother they cause.