Voiding Dysfunction and Risk Factors for Complications in Multiple Sclerosis
Alejandro Abello, MD; Anurag K. Das, MD FACS
Beth Israel Deaconess Medical Center, Brookline, MA
BACKGROUND
Multiple sclerosis (MS) is a progressive demyelinating disease affecting the central nervous system which is frequently related to voiding dysfunction and a wide range of urinary complications. However, urodynamic (UDS) changes in this population and other potential risk factors predisposing individuals with MS to develop complications is largely unknown. Therefore, in this observational study, we described the frequency of urologic complications in a cohort of MS patients, reported changes in UDS and aimed to identify characteristics that increase their odds to develop adverse outcomes.
METHODS
After IRB approval, patients diagnosed with MS who had been followed regularly by urology with serial UDS were analyzed. Other characteristics including lower urinary tract symptoms (LUTS), expanded disability status score (EDSS), complications, creatinine and imaging were recorded at each visit. Univariable and Multivariable logistic regression were performed for independent variables.
RESULTS
The study cohort included 107 MS patients with a mean age at diagnosis of 37. Patients were followed by Urology for a mean of 97 months (Table 1). At baseline, 73% had Relapse-Remitting (RR) subtype; mean EDSS was 3.2. LUTS were present in all participants during first visit; the most common complaints were: Incontinence (72%) and urgency (71%). The 2 most frequent UDS patterns were Detrusor Overactivity (DO) + Dyssynergia (DSD) and DO alone in 32% and 20% respectively (Table 2). During follow-up, MS progressed in 39% and EDSS progressed to a mean of 5.6, with 54% of the cohort developing ≥ 1 complication. The most common complication was lower urinary tract infections (UTI). Complicated UTIs, bladder or kidney stones, and persistent hydronephrosis were rare and presented in less than 10%. There were no cases of chronic renal failure secondary to MS during follow-up. After multivariable analysis, EDSS > 6.0 (OR 7.2, 95% CI 2.8-18; P value < 0.001) and EDSS progression >2.5 (OR 4.8, 95% CI 2.0-11.7; P value <0.001) were significantly associated with increased odds for overall urologic complications. Bladder capacity significantly decreased during follow-up but was not related to complications after analyses. No other UDS parameter or changes in voiding function reached statistical significance.
CONCLUSIONS
While LUTS and changes in voiding function are frequent and difficult to control, these were not related to adverse outcomes in our study population. Furthermore, serious complications like upper tract deterioration were rare in this cohort. Complications in MS approximated the overall worsening status of the primary neurologic disease process and resultant increase in total disability.
Source of funding: None
Conflicts of interests: None
Table 1: Baseline patient characteristics and complications frequency
| Age at Diagnosis ± SE | 37.1 ± 11.4 |
| Sex (%) -Female -Male | 80 20 |
| Initial MS subtype (%) -Relapse/Remitting -Primary Progressive -Secondary Progressive | 73 5 22 |
| Baseline EDSS ± SE | 3.2 ± 1.5 |
| MS subtype progression (%) -Yes -No | 61 39 |
| Follow-up EDSS ± SE | 5.6 ± 2.0 |
| Complications (%) -Lower UTI -Pyelonephritis -Urosepsis -Kidney stones -Bladder stones -Acute renal failure -Persistent hydronephrosis -Chronic renal failure | 58 7 7 7 6 6 1 0 |
| Total years of follow-up ± SE | 97 ± 49.4 |
Table 2: UDS changes during follow-up
| Baseline UDS | Follow-up UDS | ||
| Detrusor (%) -Normal -DO -DSD -Detrusor Underactivity (DU) -DO + DSD -DU + DSD | 14 21 19 9 32 5 | 14 17 31 5 29 4 | |
| P value (Paired T-test) | |||
| Bladder Capacity | 304.4 ml | 254.5 ml | 0.02 |
| Pdet.Qmax | 35.3 cmH2O | 27.7 cmH20 | 0.1 |
| Qmax | 10.1 ml/s | 7.7 ml/s | 0.1 |
| PVR | 147.2 ml | 137 ml | 0.2 |
| Voided Volume | 158.8 ml | 169 ml | 0.1 |
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