Multiple Sclerosis (MS) is the most frequent cause of non-traumatic neurogenic lower urinary tract dysfunction (NLUTD). Therefore urologists should be aware to avoid urological complications of this disease. For MS patients NLUTD not only leads to increasing risk for the upper urinary tract, but also seriously affects their quality of life (QoL), since it has been described that urinary problems have a major psychological impact and are among the most socially disabling consequences of MS.

In a previous study we found a relationship between recurrent urinary tract infections and lower urinary tract dysfunction (LUTD) in patients with MS (1). In this study we hypothesize that QoL of these patients may be affected by LUTD due to their NLUTD. Consequently the aim of our study is to investigate the relationship between QoL and LUTD

Study design 
Cross sectional study

Materials and methods 
We carried out a cross sectional study among patients with MS between September 2017 and December 2018. Inclusion criteria were: male and female patients over 18 years of age and diagnosis of MS according to McDonald Revised criteria. Exclusion criteria were: previous pelvic surgery, active urinary tract infection or presence of LUTD secondary to causes other than MS such as urogenital prolapse in women, benign prostatic hyperplasia, primary bladder neck obstruction, urethral stricture or other neurological diseases.
A total of 66 patients were recruited for this study: 25 men and 41 women. The mean ± standard deviation age was 50 ± 9, 6 years. All patients completed the Qualiveen questionnaire and were submitted to a urodynamic study in accordance with the specifications of ICS and the guidelines of Good Urodynamic Practice.

Sample size was calculated based on the data provided by Anquetil et al. (2) Assuming a limitations/inconvenience score difference of 0.817 points, a standard deviation of 0.926 points, an alpha level of 5%, and a statistical power of 80%, the minimum sample size was calculated at 21 patients per group.

For statistical analysis we used the t-test to compare the means of parametric data, and Pearson correlation coefficient (r). Data were tested for normal distribution using the Kolmogorov-Smirnov test. Statistical significance was set at P < 0.05.

The mean ± standard deviation scores were as follows: Constraints/restrictions: 1.642 ± 0.840; Limitations/inconvenience: 1.837 ± 0.924; Fears: 1.689 ± 0.861; Feelings/impact on daily life: 1.724 ± 0.954; Qualiveen, SIUP: 1.711 ± 0.688. Women had significantly worse scores than men regarding Constraints, Fears and Qualiveen SIUP.
Tables 1 and 2 shows the relationship between Qualiveen items and urodynamic data in both male and female patients.

Men showed a direct relationship between post void residual in uroflowmetry and Constrains and an inverse relationship between bladder compliance (BC) and Bladder contractility Index (BCI), W8020 parameter and Limitations and between BCI and W80W20 and Qualiveen SIUP. On the other hand, women with detrusor overactivity (DO), showed a significantly worse score in Constrains that those without DO and an inverse relationship between BC and Constraints.

The results confirm our hypothesis that LUTD influences Qol in these patients.  However, this influence was different between male and female patients. 

Negative impact of lower urinary tract symptoms (LUTS) in Qol has been demonstrated in patients with MS, especially urinary urgency (3). Unfortunately the relationship between LUTS and LUTD in MS patients is weak. To our knowledge this is the first study that directly links LUTD and Qol in patients with MS.

According to this weak relationship between LUTS and LUTD, although DO is the most common finding in patients with MS, our study reveals that its impact on QoL was only significant in women. On the other hand, detrusor underactivity is less frequent in these patients. However, this dysfunction has a significant influence on Qol of men. Regarding bladder compliance its dysfunction is rare in MS patients but our study showed that it was the only urodynamic datum that influenced on Qol of both sexes.

The results confirm our hypothesis that LUTD influences Qol in these patients.  However, this influence was different between male and female patients. 

Negative impact of lower urinary tract symptoms (LUTS) in Qol has been demonstrated in patients with MS, especially urinary urgency (3). Unfortunately the relationship between LUTS and LUTD in MS patients is weak. To our knowledge this is the first study that directly links LUTD and Qol in patients with MS.

According to this weak relationship between LUTS and LUTD, although DO is the most common finding in patients with MS, our study reveals that its impact on QoL was only significant in women. On the other hand, detrusor underactivity is less frequent in these patients. However, this dysfunction has a significant influence on Qol of men. Regarding bladder compliance its dysfunction is rare in MS patients but our study showed that it was the only urodynamic datum that influenced on Qol of both sexes.

Castro-Díaz D M, Vírseda-Chamorro M, Salinas-Casado M, Méndez-Rubio S, Esteban-Fuertes M2, Moreno-Sierra J. Clinical and urodynamic risk factors for recurrent urinary tract infections in patients with multiple sclerosis. ICS Meeting.  Abstract 505. Philadelphia, 2018
Anquetil C, Abdelhamid S, Gelis A, Fattal C Botulinum toxin therapy for neurogenic detrusor hyperactivity versus augmentation
Khalaf KM, Coyne KS, Globe DR, Malone DC, Armstrong EP, Patel V, Burks J. The impact of lower urinary tract symptoms on health-related quality of life among patients with multiple sclerosis Neurourol Urodyn. 2016; 35(1):48-54