Multiple sclerosis (MS) is an autoimmune progressive neurological disease with a diverse range of urological symptomatology, since most MS patients experience one or more moderate to severe urinary symptoms, as well as bladder and/or sexual disorders. The severity of LUTS and their presentation may show considerable variation among MS patients as a result of the multifocal and diffuse involvement of the CNS. Roughly 70% of MS patients indicated that they experienced a moderate or severe impact on their quality of life as a result of LUTS [1]. Aim of the study is to evaluate the impact of LUTS and sexual dysfunctions in MS male patients in their marital relationship.

After local IRB approval, all MS male patients arrived to our attention were prospectively enrolled in the study. All Patients were evaluated with Expanded Disability Status Scale (EDSS) (Kurtzke JF, 1983), IIEF-5 for sexual function, ICIQ-MLUTS for urinary function, Dyadic Adjustment Scale (DAS) for marital relationship. The data were analyzed using descriptive and inferential statistical tests in STATA /MP14.

Forty consecutive male patients with a diagnosis of MS were included in this study. All patients had some grade of lower urinary tract symptoms (LUTS). 55% (n=22) of the patients had urinary incontinence (UI). 52.5% (n=21) of patients with MS reported urge urinary incontinence (UUI). 20% (n=7) of patients with MS reported mixed urinary incontinence (MUI). Neurological deficit measured by EDSS was found to positively correlate with LUTS (r=0.38, p<0.01) and negatively correlate with DAS (r=-0.43, p<0.01) and IIEF-5 (r=-0.29, p<0.01). The grade of LUTS negatively correlate with the IIEF-5 (r= -0.39, p<0.01). Moreover, multiple logistic regression analysis confirmed that there was a higher probability of relationships problems (DAS) among patients with MS and a high EDSS score [-5.9 (95% C.I. -10.92969   -0.908043), P < 0.05].

This initial study in a small number of patients demonstrated the large negative impact that LUT and sexual dysfunctions due to multiple sclerosis have on patients' marital relationship, as measured by the DAS. This approach is new in the literature and demonstrates the need for a multidisciplinary patient approach in the management and follow-up of a MS patient.

A multidisciplinary patient approach in the management and follow-up of a MS patient is needed and could improve the outcome in therms of disease management and quality of life.
A more extensive study on a greater number of patients is certainly necessary in order to have even more corroborating data.

Fowler CJ, Panicker JN, Drake M et al. A UK consensus on the management of the bladder in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009 May;80(5):470-7. doi: 10.1136/jnnp.2008.159178.