Hypothesis / aims of study
Lower urinary tract symptoms (LUTS) are frequently encountered in patients with Multiple Sclerosis (MS), yet they often remain underrecognized and undertreated. We aimed to assess the prevalence, nature, and predictors of LUTS among MS patients referred to a urology outpatient clinic, and to evaluate patterns of urological management in this population.
Study design, materials and methods
A retrospective chart review was conducted involving MS patients referred to the Urology outpatient clinic for LUTS evaluation. Electronic medical records were reviewed to collect demographic data, MS subtype and disease characteristics, urological symptoms at presentation, and details of diagnostic and therapeutic interventions. All Urologic assessments were performed by trained urologists and included a systematic questioning of the LUTS, urine analysis, uroflowmetry and postvoid residual measurement. The primary outcomes were symptom profiles, referral patterns, and treatment modalities.
Results
A total of 247 MS patients were included. Of these, 166 (67%) were female and 81 were male. The mean age at first symptom onset was 33.1±10.9 years, and the average disease duration was 11.1±8.7 years. 238 patients (96.4%) were on disease-modifying treatment listed in Table 1. The average age at first urology referral was 41.5±12 years. Patients with an initial disease type of primary progressive MS (PPMS) were more likely to suffer from a LUTS compared to relapsing remitting MS (PPMS:RRMS, 49.3±10.7 vs. 38.8±11.2, p < 0.001). The most common referral symptoms to urology were storage-related issues, with urinary incontinence being the most frequent. Among those with incontinence, 71% were female and 29% were male. Voiding problems were observed in 42% of the patients, with the most common complaint being the sensation of post-micturition residual urine (n = 68, 27.5%). No statistically significant relationship was found between bladder problems and the number of relapses or RRMS status. Recurrent urinary tract infections were observed at similar rates in PPMS (11.48%) and RRMS (11.29%) patients, but were more than twice as frequent in females (13.86%) compared to males (6.17%). Although no gender difference was noted in the history of intermittent self- catheterization (ISC), it was found to be more common in PPMS patients. Of all patients referred and assessed in the Urology Outpatients 76 (31.9%) were treated conservatively; 105 (44.1%) had medical therapies (such as anticholinergics, beta-3-agonists) and 57 (23.9%) had invasive treatments (such as botox injections and ISC).
Interpretation of results
LUTS are prevalent in MS patients, especially in those with progressive disease. Despite their significant impact on quality of life, these symptoms often remain inadequately addressed. Female patients, patients with incontinence and those with PPMS appear to be at increased risk for both incontinence and more intensive urological management. The variability in treatment underscores the need for individualized assessment and care.