Lower Urinary Tract Symptoms Should Be Assessed in MS Cases
Clinical evaluation of multiple sclerosis (MS) patients should include the assessment of lower urinary tract symptoms (LUTS) alongside neurological ones, according to a recent study.
The study, “Lower urinary tract dysfunction in patients with multiple sclerosis: A post-void residual analysis of 501 cases,” was published in the journal Multiple Sclerosis and Related Disorders.
Urinary tract disorders occur frequently with MS, with a prevalence that ranges from 32–96.8% of cases, and they can have a significant impact on quality of life.
One measure that neurologists have found useful in assessing urinary problems is the post-void residual (PVR) test, which measures the volume of urine left in the bladder at the completion of urinating, or the post-void residual volume. Done by ultrasound, it is a non-invasive test for evaluating urinary dysfunction.
Despite its reported utility among patients with neurological disorders such as MS, little evidence supports its use as a clinical tool. Also, values that define what constitutes MS-related urinary retention are not well established.
A team of researchers from the Italian Multiple Sclerosis Society (AISM) and the University of Siena conducted a study to better understand how PVR volume is distributed among MS patients with and without LUTS, as well as to assess the relationships between PVR and the symptoms of storage versus voiding.
In total, 501 MS patients (mean age 56) were recruited from the AISM Rehabilitation Service in Genoa, Italy. The team designed a questionnaire to investigate both clinician-assessed and patient-reported outcomes on LUTS.
Patients in the study showed a high prevalence of LUTS, at 91.4%, or 458 patients. Of those, 130 (28.4%) had documented recurrent urinary tract infections, 437 (87.2%) reported storage-related symptoms, and 326 (65.1%) reported at least one voiding-related symptom. Two-thirds of the patients (66.5%) in the study reported three or more LUTS.
The most frequently reported storage symptoms were urgency and urge incontinence. The most common voiding-related symptoms were incomplete emptying and intermittency.
The more urinary infections patients reported, the more likely they were to experience LUTS. Furthermore, the presence of LUTS and number of symptoms correlated with the volume of PVR.
Although there is not yet a universally accepted value for MS-related urinary retention, the study found an average PVR volume of 132.4 milliliters (mL) among MS patients, which was considered abnormal. (A PVR greater than 100 mL is considered an abnormal residual urine volume.)
Contributing to this average value, 51.5% of subjects had a PVR of at least 100 mL and 10.6% had a PVR of 300 mL or greater.
Other factors that correlated with increased PVR volumes included male sex, greater MS severity (as measured by EDSS scores), and a progressive disease course. Higher PVR values were found in patients with progressive forms of MS.
Overall, the “results showed a high prevalence of LUTS in subjects with MS and that storage symptoms are predominant. There was an association between the presence of LUTS and a progressive disease course,” the researchers concluded.
“The relationship between LUTS, higher PVR and the severity of disease course indicates that a comprehensive clinical evaluation should include an assessment of both neurological and micturition [urination] disorders and, importantly, PVR should be measured at every clinical assessment, despite the presence or absence of LUTS,” the team added.
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