ABSTRACT
BACKGROUND: Multiple sclerosis patients often develop neurogenic lower urinary tract dysfunction with a potential risk of upper urinary tract damage. Diagnostic tools are urodynamics, bladder diary, uroflowmetry, and post-void residual, but recommendations for their use are controversial. OBJECTIVE: We aimed to identify clinical parameters indicative of neurogenic lower urinary tract dysfunction in multiple sclerosis patients. METHODS: 207 patients were prospectively assessed independent of the presence of lower urinary tract symptoms. We analyzed Expanded Disability Status Scale scores, uroflowmetry, post-void residual, rate of urinary tract infections, standardized voiding frequency, and voided volume in correlation with urodynamic findings. RESULTS: We found a significant correlation between post-void residual (odds ratio (OR) 4.17, confidence interval (CI) 1.20-22.46), urinary tract infection rate (OR 3.91, CI 1.13-21.0), voided volume (OR 4.53, CI 1.85-11.99), increased standardized voiding frequency (OR 7.40, CI 2.15-39.66), and urodynamic findings indicative of neurogenic lower urinary tract dysfunction. Expanded Disability Status Scale shows no correlation. Those parameters (except post-void residual) are also associated with reduced bladder compliance, as potential risk for kidney damage. CONCLUSION: Therefore, bladder diary and urinary tract infection rate should be routinely assessed to identify patients who require urodynamics.
ABSTRACT
AIMS: Driven by increasing awareness of antibiotic stewardship, especially in the vulnerable group of patients with neurogenic lower urinary tract dysfunction (NLUTD), whose frequent need for invasive interventions leads to a high incidence of recurrent urinary tract infections (rUTIs), the goal was to find an alternative to antibiotic treatment. Our intention was for the treatment to be locally administered and well-tolerated as well as to avoid the risk of antimicrobial resistance. METHODS: A retrospective analysis of 12 catheterized NLUTD patients was performed within the setting of an individual curative trial. The decision to implement the investigational intervention was made on an individual basis with the aim of eliminating lower urinary tract bacteria before diagnostic procedures or to treat rUTI. Electrochemically activated solution (ECAS) was used as bladder irrigation (BI). The following assessments were undertaken: microbiological analysis of urine, analysis of leukocytes/erythrocytes (per µl urine); microbial resistance and sensitivity to antibiotics before and after therapy; clinical signs and patients' state of health. RESULTS: Eradication of bacteria or an increase in microbial sensitivity to antibiotics was observed in 50%-70% of patients. No adverse events were seen. Due to the restrictions of an individual curative trial, the results are limited by the small number of patients and the absence of a control group. CONCLUSION: In NLUTD patients with rUTIs, the use of ECAS BI to eliminate bacteriuria before invasive procedures (e.g., urodynamics, preoperative procedures) or to treat rUTI was shown to be a promising alternative to antibiotic treatment.
