When evaluating multiple sclerosis (MS) patients with lower urinary tract symptoms (LUTS), clinicians rarely order urodynamics and rely instead on history, ultrasound, uroflowmetry and bladder diary (BD) to clearly evaluate the patient’s lower urinary tract function. BD is the only objective patient-generated method that portrays the real-life scenario and embodies a home-monitoring of patients. Yet, its utility is still questioned. The aim of the study was to assess the necessity of a bladder diary when evaluating a MS patient with LUTS.

This is an IRB-approved observational study. 44 patients with MS and LUTS were included. They underwent a Bladder Ultrasound from which the bladder volume and post void residual volume were evaluated and the urinated volume (Vus) was thus calculated. Then a uroflowmetry was done, from which the urinated volume (Vuf) was assessed, and urodynamic studies were performed from which volumes corresponding to B1 (Vb1), B2 (Vb2), B3 (Vb3) and maximal bladder capacity (Vc) were evaluated. A 24 hour-voiding diary was filled by the patients : minimal (Vmin), mean (Vmean), and maximal (Vmax) urinated volumes were calculated. We assessed the agreement between the urinated volume based on ultrasound and uroflowmetry, and the urinated volume range of the voiding diary, in a sample of 24 patients (sample 1). Then, we assessed the agreement between the bladder volume on ultrasound and the different volumes obtained in the urodynamic studies, in another sample of 20 patients (sample 2). The patients were chosen in each sample based on the tests they have undergone.

In sample 1, 50% of patients (12/24) had their Vuf outside the voiding diary volume range [Vmin-Vmax], and 46% (11/24) had their Vus outside the voiding diary volume range (fig1a). In sample 2, 15% (3/20) had their Vus below Vb1; 25% (5/20) had their Vus in [Vb1-Vb2] range; 25% (5/20) had their Vus in [Vb2-Vb3] range; 10% (2/20) had their Vus in [Vb3-Vc] range; and 25% (5/20) had their Vus above Vc (fig1b).

Evaluating the urinated volume using ultrasound and uroflowmetry seems instantaneous and different from the bladder diary which represents more the real-life scenario. The ultrasound volume is heterogeneously distributed among the cystomanometry capacities (B1, B2, B3 and maximal capacity).

Clinicians should consider relying more on bladder diary (not only frequency but also minimal and maximal urinated volumes) as a home-monitoring of lower urinary tract function in MS patients with LUTS. Future randomized-controlled trials should be undergone in order to confirm these findings.