Hypothesis / aims of study
Lower urinary tract dysfunction (LUTD) is a prevalent and debilitating condition in patients with multiple sclerosis (MS), impacting up to 96% of individuals and leading to a substantial decrease in quality of life [1].The hypothesis of this study is that urodynamic studies (UDS) can play a crucial role in diagnosing and managing LUTD in MS patients, guiding treatment decisions, and preventing complications such as upper urinary tract damage and recurrent urinary tract infections (UTIs). This systematic review aims to evaluate the diagnostic accuracy, clinical impact, and prognostic value of UDS in MS-related LUTD, while also addressing the challenges and limitations of their use.
Study design, materials and methods
A comprehensive systematic review was conducted in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Research articles were identified through systematic searches in PubMed, Embase, Scopus, and Web of Science, covering studies published from 2000 to 2024 . Keywords included “urodynamics,” “multiple sclerosis,” “lower urinary tract dysfunction,” and “neurogenic bladder.” Studies included in the review were those that assessed the role of UDS in diagnosing or managing LUTD in MS patients. The quality of studies was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist to ensure methodological rigor and reliability. Data extraction included study design, sample size, patient characteristics, urodynamic findings, and treatment outcomes.
Results
A total of 47 studies, encompassing 6,732 MS patients, were analyzed. The included studies featured various designs, such as randomized controlled trials, cohort studies, cross-sectional studies, and retrospective analyses. The most common urodynamic findings across the studies included neurogenic detrusor overactivity (NDO) in 65%, detrusor sphincter dyssynergia (DSD) in 45%, impaired bladder compliance in 30%, and detrusor underactivity (DU) in 22%. UDS had a significant impact on treatment decisions in 68% of the studies reviewed. Key treatment decisions influenced by UDS findings included pharmacologic interventions (antimuscarinics, beta-3 agonists, alpha-blockers), botulinum toxin injections, neuromodulation, clean intermittent self-catheterization (CISC) and cystoplasty. Furthermore, high-risk urodynamic profiles—particularly those with poor bladder compliance or elevated detrusor pressures—were associated with a 3.2-fold increased risk of upper urinary tract complications, emphasizing the importance of early and continuous monitoring. Some studies incorporated videourodynamics, particularly in cases of progressive MS, to enhance diagnostic accuracy. (Figure 1)
Interpretation of results
The findings from the reviewed studies demonstrate the critical role of UDS in diagnosing and managing LUTD in MS. UDS not only aids in identifying the type of bladder dysfunction but also significantly influences treatment decisions, guiding clinicians in choosing appropriate pharmacologic and non-pharmacologic interventions. The results also highlight that high-risk urodynamic profiles, particularly poor bladder compliance and elevated detrusor pressures, are predictive of increased risks of renal damage and recurrent UTIs, underscoring the importance of timely intervention. Despite the overall positive impact of UDS, there is variability in study methodologies and conclusions, with some studies questioning the routine use of invasive urodynamic testing and suggesting that it should be reserved for patients with specific clinical risk factors or severe symptoms [2]. This indicates the need for a more personalized approach to the application of UDS in clinical practice.