Urodynamics assessment in patients with multiple sclerosis

Abstract

Objectives: The aim of this study is to review initial urodynamics (UDS) findings in patients with multiple sclerosis (MS) related lower urinary tract symptoms, establish where UDS happen in treatment pathways and to evaluate the benefit of video over standard UDS.

Patients and Methods: OnaBotulinumToxin A (BTX-A) naïve, MS patients who had undergone UDS were identified from prospectively maintained databases from UK hospitals.

Results: One hundred fifty-seven patients were identified from seven UK departments. One (0.9%) female patient and 3 (6.7%) males had end fill pressures > 40 cmH2O. No female and two (5.1%) males showed vesico-ureteric reflux. Of female patients reporting pure overactive bladder (OAB) symptoms, 61 (67.2%) showed neurogenic detrusor overactivity (NDO), 10 (11.1%) showed loss of compliance (LoC) and 28 (31.1%) showed no NDO or LoC. Following UDS, 134 (85.4%) patients underwent management changes: 61 (72.6%) females and 25 (78.1%) males were offered non-medical treatment, oral or topical medication; 30 (30.9%) females and 7 (18.9%) males were advised to start self-catheterisation; 16 (19.0%) females and 4 (12.5%) males were offered intra-vesical BTX-A; two (2.4%) females were offered SUI surgery and one (3.1%) male was offered bladder outflow obstruction surgery.

Conclusion: Many patients underwent UDS prior to conservative and medical management, which is earlier than most guidelines recommend, potentially delaying non-invasive treatment. This study supports the need for VUDS at initial assessment of men with MS. Standard UDS suffice in women with MS and pure OAB symptoms unresponsive to conservative measures and oral medication unless they have abnormal renal function, hydronephrosis or significant post void volumes.