Voiding dysfunction due to multiple sclerosis: a large scale retrospective analysis

ABSTRACT

PURPOSE: To assess the outcome of urologic evaluation in patients with voiding dysfunction due to multiple sclerosis (MS) and to determine the relationship between urological and neurological parameters of these patients. MATERIAL AND METHODS: We retrospectively reviewed the medical records of 249 consecutive patients (162 female and 87 male) with MS who were referred to our clinic between 1991 and 2006, with a median time of 4 years (range 3 months to 26 years) of MS onset. Data was analyzed with respect to patient demographics and findings of initial evaluation. Lower urinary tract symptoms were evaluated by Boyarsky symptom index. RESULTS: All patients except 13 had lower urinary tract symptoms and 70 percent manifested mixed symptoms. Total, storage and voiding symptom scores correlated with expanded disability status scale scores (p < 0.05). Twelve patients (5 percent) had abnormal upper urinary tract. Ultrasound findings of lower urinary tract were abnormal in 12 patients (5 percent). No demographic parameters were associated with abnormal findings of upper urinary tract on univariate analysis. Urodynamic evaluation of 75 patients (30.1 percent) revealed detrusor overactivity with or without detrusor-sphincter dyssynergia in 56 (75 percent). No correlation was found between urodynamic diagnosis and upper tract deterioration and urinary symptom scores (p > 0.05). CONCLUSIONS: The prevalence of mixed symptoms in patients with MS is higher than storage or voiding symptoms alone. Although detrusor overactivity and detrusor-sphincter dyssynergia were the most common urodynamic diagnoses, upper urinary tract deterioration was rare in our series.