Neurogenic lower urinary tract dysfunction (NLUTD) is very frequent in presence of multiple sclerosis (MS)(1). Despite the high prevalence of lower urinary tract symptoms (LUTS), risk of renal function deterioration remains low when compared to other neurologic pathologies, such as myelomeningocele and spinal cord injury. For this reason, the need of urodynamic evaluation in these patients remains unclear(2). The aim of our study is to assess the existence and significance of pathological urodynamic findings in multiple sclerosis patients with mild LUTS.

We retrospectively included 75 MS patients referred for primary neurourological work-up. Clinical parameters taken into account were age, sex, type and duration of MS and Expanded Disability Status Scale (EDSS). A health questionnaire was initially offered to all patients. Presence of dysuria, pollakiuria, urgency and incontinence were evaluated. Patients were split into two groups. Mildly symptomatic if they had 0 or 1 and moderately symptomatic if they presented 2 of these symptoms. 
All patients underwent a standard video-urodynamic exam. Correlation between clinical picture and urodynamic findings such as post void residual volume >150 ml (PVR), detrusor overactivity (DO) and detrusor sphincter dyssynergia (DSD) was assessed. Data were analyzed in Stata (StataCorp LLC, Texas, USA) using, t-test chi-square test and logistic regression methods.

Our population was split into two groups: 26 patients with mild and 49 with moderate symptoms.  Groups didn’t differ significantly except for EDSS score, which was higher in the moderate symptoms group (2 (1.5 - 3.5) Vs 3.5 (2.5 - 4.5) , p< 0,001) et The mild LUTS group mainly complained of dysuria (34.6%) while in the moderate LUTS group, urgency was the most prevalent symptom, which was present in 85.7% of the patients. Detrusor overactivity was significantly more frequent in patients with moderate LUTS (23% vs 55%). Multivariate analysis showed urgency as a significant predictive factor for detrusor overactivity (odds ratio = 4.5, 95% confidence interval (CI) = 1.64 – 15.73, p = 0.01). Dysuria was significantly associated with DSD (odds ratio = 5.07, 95% confidence interval (CI) = 1.52 – 16.88, p = 0.008) and pathological PVR (odds ratio = 15.45, 95% confidence interval (CI) = 3.3 – 71.67, p = <0.001). In univariate analysis, EDSS was correlated with DO and pathological PVR, although in multivariate analysis, this was not confirmed. A p-value < 0.05 was defined as significant.

Urgency is present in more than two third of patients with moderate LUTS and seems to be a good predictor of DO. Dysuria, on the other hand, was significantly correlated with DSD and pathological PVR (>150ml). These findings were independent of type of MS, disease duration and EDSS. Accordingly, in patients presenting with urgency or dysuria, independently of the state of their neurologic disease, urodynamic testing should be considered.

Presence of dysuria or urgency in MS patients seems to be an independent predictive factor of lower urinary tract dysfunction. In their presence, urodynamic evaluation should be considered.

Koldewijn EL, Hommes OR, Lemmens WA, et al. Relationship between lower urinary tract abnormalities and disease-related parameters in multiple sclerosis. J UROL 1995; 154: 169-173
De Seze M, Ruffion A, Denys P, et al. The neurogenic bladder in multiple sclerir : Review of the literature and proposal of management guidelines. Mult Scler 2007; 13: 915-928