Expanded Disability Status Scale (EDSS) and Lower Urinary Tract Dysfunctions in Patients with Multiple Sclerosis

Torad H1, Abdelazim M1, Hussein H1, Shalaby N1, Sadek S1, Khalifa A2, Abdelaziz A1

Research Type


Abstract Category


Abstract 375
E-Poster 2
Scientific Open Discussion ePoster Session 18
Thursday 5th September 2019
13:10 - 13:15 (ePoster Station 9)
Exhibition Hall
Multiple Sclerosis Voiding Dysfunction Overactive Bladder
1.Kasr El Aini Faculty of Medicine, Cairo University, Egypt, 2.Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA. and Department of Urology, Menoufia University, Egypt.

Hesham Torad



Hypothesis / aims of study
Multiple sclerosis (MS) is a devastating neurological disease that attacks young adults and affects all aspects of their lives. Urinary
dysfunction in MS has a significant impact on quality of life with more than 80% of those with MS reporting urinary symptoms. 
We aimed to study the urodynamic characteristics of urinary tract dysfunction secondary to multiple sclerosis (MS) and to investigate the possible relationship between the Expanded Disability Status Scale (EDSS) and lower urinary tract
dysfunctions in patients with multiple sclerosis.
Study design, materials and methods
After obtaining the IRB approval and informed consents, patients were recruited through the outpatient clinic and followed up for one year.  The Expanded Disability Status Scale is a method of quantifying disability in multiple sclerosis. The EDSS
quantifies disability in eight Functional Systems (FS): Pyramidal functions, Cerebellar functions, Brainstem functions, Sensory functions, Bowel and bladder functions, Visual functions, Mental functions, and other functions. The patient is then assigned a functional system score. EDSS scores up to 4.5 refer to people with MS who have no impairment in their daily activity and need no or mild assistance. EDSS scores of 5.0 or more defined by the disability severe enough to impair full daily activity. The severity of urological symptoms is calculated by the AUA symptom score. And every patient will have a score from 0-35. According to the score, patients will be divided into. mild (0-9), moderate (10-19) and severe (20-35). Magnetic Resonance Imaging of the brain and spinal cord were performed for patients on a 1.5 Tesla Phillips Intera® Scanner at the Magnetic Resonance Unit, Department of Radiodiagnosis, Cairo University, during the period of patient admission. Statistical evaluation was conducted using SPSS 20.
The study included 120 patients. It included 38 male patient (31.7%) and 82 female (68.3%) with mean age (35.2±10) years for all the group. There was multi-system affection by the disease as (100%) suffered from bladder affection, (95%) suffered from motor
system affection and least system affected was cognitive functions by percent (1.7%). MRI was done to all patients. Brain periventricular affections presented in 85% of patients, brain juxtacortical affections  in 56.7%, CS affections in 36.7% and DS affections in 1.7%. Bladder function was the most affected function by the disease in the cohort. Urodynamic studies were conducted to detect the dysfunction occurring in MS patients. Only 10% had normal urodynamics. The most common bladder
dysfunction was an overactive bladder in 35% of the patients, overactive bladder + DSD in 26.7%, atonic bladder in 11.7%, DIs in 10%, and the DSD alone in 6.7%. 
Regarding EDSS measurement EDSS% of change with median 0% and (0% - 0%) interquartile range in No urinary recovery group and median 0%, (-0.08% - 0%) interquartile range in urinary recovery group. Expanded Disability Status Scale (EDSS) was measured between the whole sample with a mean of 4.8±1.8, the last EDSS was measured with a mean of 4.7±1.8. EDSS was measured with a mean (2.2±1.1) and (1.9±1.1) in No-urinary-recovery group versus urinary-recovery group respectively (p-value >0.05).
Interpretation of results
This study was conducted on 120 patients with clinically definite multiple sclerosis according to the McDonald diagnostic criteria. The severity of urinary system decreased by time, 1st month was reported with mean score (18±6.6) versus (10.3±4.7) after 1 year.
Regarding EDSS measurement at 1st the mean was (4.8±1.4) and (4.8±1.8), last EDSS mean (4.8±1.3) and (4.7±1.8) in Non-urinary-recovery group and urinary recovery group respectively. The measurement of 1st EDSS and the last EDSS changed in the 2
measurements, So EDSS the same at first and at last 8 (66.7%) and 58 (53%), decreased in measurement 2 (16.7%) and 38 (35.2%), Increased in measurement 2 (16.7%) and 12 (11.1%) in Non urinary recovery group and urinary recovery group respectively. EDSS% of
change with median 0% and (0% - 0%) interquartile range in No urinary recovery group and median 0%, (-0.08% - 0%) interquartile
range in urinary-recovery group. As the bladder function was the most system affected by MS, EDSS was measured with mean (2.2±1.1) and mean (1.9±1.1)in Non-urinary-recovery group and urinary recovery group respectively. There is No statistical significance in the examination of the relation between 2 groups as p-value not <0.05.

There is statistical significance between 1st-month LUTs severity and 1st total EDSS, it is a positive weak correlation “r=0.39” and this correlation confirmed as p-value= <0.001. Correlation between one-year severity and last EDSS is also confirmed as p-value=0.003 and this correlation is positive weak correlation also, but there is no correlation between urinary symptoms change and EDSS% of change as p-value= 0.448.
Concluding message
Although patients with high scores in EDSS were found to have detrusor overactivity with significant correlation was found
between EDSS and results of urodynamics. The site of lesion in MRI isn’t a predictor for the course and fate of
neurogenic bladder in MS. Urinary dysfunction in MS has a significant impact on quality of life with more than 90% of those with MS reporting urinary symptoms. Urodynamic evaluation is essential in the evaluation and management of voiding dysfunction in patients with MS. The duration of disease and type of MS are not predictors of course and fate of neurogenic bladder. Urological evaluations of all MS patients is advisable for early diagnosis and management of neurogenic bladder in MS patients
Funding none Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics Committee Cairo University Ethics committee Helsinki Yes Informed Consent Yes