High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis

2017 ◽  
Vol 24 (4) ◽  
pp. 529-534 ◽  
Author(s):  
Benjamin V Ineichen ◽  
Marc P Schneider ◽  
Martin Hlavica ◽  
Niels Hagenbuch ◽  
Michael Linnebank ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Urinary Tract ◽  
Roc Curves ◽  
Clinical Parameter ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Consecutive Series ◽  
Clinical Parameters ◽  
Tract Damage

Background: Neurogenic lower urinary tract dysfunction (NLUTD) is very common in patients with multiple sclerosis (MS), and it might jeopardize renal function and thereby increase mortality. Although there are well-known urodynamic risk factors for upper urinary tract damage, no clinical prediction parameters are available. Objective: We aimed to assess clinical parameters potentially predicting urodynamic risk factors for upper urinary tract damage. Methods: A consecutive series of 141 patients with MS referred from neurologists for primary neuro-urological work-up including urodynamics were prospectively evaluated. Clinical parameters taken into account were age, sex, duration, and clinical course of MS and Expanded Disability Status Scale (EDSS). Results: Multivariate modeling revealed EDSS as a clinical parameter significantly associated with urodynamic risk factors for upper urinary tract damage (odds ratio = 1.34, 95% confidence interval (CI) = 1.06–1.71, p = 0.02). Using receiver operator characteristic (ROC) curves, an EDSS of 5.0 as cutoff showed a sensitivity of 86%–87% and a specificity of 52% for at least one urodynamic risk factor for upper urinary tract damage. Conclusion: High EDSS is significantly associated with urodynamic risk factors for upper urinary tract damage and allows a risk-dependent stratification in daily neurological clinical practice to identify MS patients requiring further neuro-urological assessment and treatment.

Neurogenic lower urinary tract dysfunction in the early disease phase of paediatric multiple sclerosis

2016 ◽  
Vol 22 (11) ◽  
pp. 1490-1494 ◽  
Author(s):  
Jeroen R Scheepe ◽  
Yu Yi M Wong ◽  
E Daniëlle van Pelt ◽  
Immy A Ketelslegers ◽  
Coriene E Catsman-Berrevoets ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Early Disease ◽  
High Prevalence ◽  
Potential Damage ◽  
Urinary Problems ◽  
Lower Urinary

Neurogenic lower urinary tract dysfunction (LUTD) in multiple sclerosis (MS) is highly prevalent in adults, but has not previously been described in paediatric MS. A total of 24 consecutive children with newly diagnosed MS were prospectively assessed for bladder and bowel problems early after diagnosis. Five of 24 children (21%) showed LUTD during assessment. One of these patients did not report voiding complaints. This high prevalence of LUTD indicates that all recently diagnosed patients with paediatric MS should be evaluated early in their disease and treated for urinary problems in order to prevent potential damage to the upper urinary tract.

High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis

2017 ◽  
Vol 16 (3) ◽  
pp. e281 ◽  
Author(s):  
M.P. Schneider ◽  
B. Ineichen ◽  
N. Hagenbuch ◽  
M. Linnebank ◽  
T. Kessler
Keyword(s):  
Multiple Sclerosis ◽  
Urinary Tract ◽  
Upper Urinary Tract ◽  
Tract Damage

scholarly journals Role of Uroflowmetry in Children with Ano-Rectal Malformation in Anticipating Upper Urinary Tract Damage

2017 ◽  
Vol 53 (02) ◽  
pp. 090-096
Author(s):  
Rahul Saxena ◽  
Arvind Sinha ◽  
Manish Pathak ◽  
Avinash S Jadhav ◽  
Ankur Bansal
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Asymptomatic Children ◽  
Determine Role ◽  
Urinary Tract Symptoms ◽  
Tract Damage ◽  
Lower Urinary

ABSTRACT Background: The lower urinary tract dysfunction (LUTD) has high incidence in children with anorectal malformation (ARM) which if left untreated leads to upper tract damage. Aim: To determine role of uroflowmetry in early diagnosis of LUTD in children with ARM. Methods: This prospective study included twenty consecutive patients of ARM and every patient underwent uroflowmetry at-least 6 weeks after definitive procedure. Results: The mean age of patients was 3.015±0.86 years. Of the twenty patients, there were 12 (60%) males and 8 (40%) females; 11 (55%) were high ARM, 4 (20%) were intermediate and 5(25%) were low ARM. Lower urinary tract symptoms (LUTS) was present in 8/20 (40%) patients but uroflowmetric abnormalities were present in 11/20 (55%) patients. Forty five percent (5/11) patients with abnormal uroflowmetry were asymptomatic and 25% (2/8) symptomatic patients had normal uroflowmetry. The incidence of uroflowmetric abnormalities was significantly higher in patients with spinal anomalies (p=0.03; χ2=4.1) and those with high ARM (p=0.004; χ2=8.1). Conclusion: Uroflowmetry is a noninvasive method that may help in early detection of neurovesical dysfunction in asymptomatic children and subsequent cystometric analysis in patients with uroflowmetric abnormalities can be done for early definitive diagnosis and prevention of upper urinary tract damage.

scholarly journals Detrusor sphincter dyssynergia: can a more specific definition distinguish between patients with and without an underlying neurological disorder?

Spinal Cord ◽  
2021 ◽  
Author(s):  
Oliver Gross ◽  
Lorenz Leitner ◽  
Maria Rasenack ◽  
Martin Schubert ◽  
Thomas M. Kessler
Keyword(s):  
Urinary Tract ◽  
Neurological Disorder ◽  
Upper Urinary Tract ◽  
Clinical Parameters ◽  
Urodynamic Investigation ◽  
Detrusor Sphincter Dyssynergia ◽  
Severity Scores ◽  
Cord Injury ◽  
Tract Damage

Abstract Study design Cross-sectional study. Objectives To evaluate if specific definitions of detrusor sphincter dyssynergia (DSD) might distinguish between individuals with spinal cord injury (SCI) and those with no underlying neurological disorder (NO ND). Setting Single tertiary university SCI center. Methods A series of 153 individuals, 81 with traumatic SCI and 72 with NO ND, were prospectively evaluated and included in this study. All individuals underwent a clinical neuro-urological examination, a neurophysiological work-up and a video-urodynamic investigation and were diagnosed with DSD as defined by the International Continence Society (ICS). We determined the DSD grades/types according to the classifications by Yalla (grade 1–3), Blaivas (type 1–3) and Weld (type 1–2). Distribution of the DSD grades/types were compared between SCI and NO ND individuals. Associations between the various DSD grades/types and clinical parameters, such as risk factors for upper urinary tract damage (all individuals) or lower extremity motor scores, SCI injury levels and severity scores (only SCI group), were assessed. Results The distribution of all DSD types were similar between groups (p > 0.05). None of the DSD classifications allowed risk assessment for upper urinary tract damage. A significant association between DSD type and other clinical parameters could not be found (p > 0.05). Conclusions None of the investigated DSD definitions can distinguish between patients with SCI and with NO ND. The more complex DSD classifications by Yalla, Blaivas or Weld cannot compete with the ICS binary yes-no definition which is pragmatic and straightforward for managing patients in daily clinical practice. Sponsorship None.

scholarly journals Neurogenic Bladder: Epidemiology, Diagnosis, and Management

2020 ◽  
Vol 40 (05) ◽  
pp. 569-579
Author(s):  
Jalesh N. Panicker
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Renal Ultrasound ◽  
Preliminary Evaluation ◽  
Cord Injury ◽  
Tailored Approach ◽  
Tract Damage ◽  
Lower Urinary

AbstractLower urinary tract dysfunction is a common sequel of neurological disease resulting in symptoms that significantly impacts quality of life. The site of the neurological lesion and its nature influence the pattern of dysfunction. The risk for developing upper urinary tract damage and renal failure is considerably lower in patients with slowly progressive nontraumatic neurological disorders, compared with those with spinal cord injury or spina bifida. This acknowledged difference in morbidity is considered when developing appropriate management algorithms. The preliminary evaluation consists of history taking, and a bladder diary and may be supplemented by tests such as uroflowmetry, post-void residual measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the clinical indications. Incomplete bladder emptying is most often managed by intermittent catheterization, and storage dysfunction is managed by antimuscarinic medications. Intra-detrusor injections of onabotulinumtoxinA have revolutionized the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. In select patients, reconstructive urological surgery may become necessary. An individualized, patient-tailored approach is required for the management of lower urinary tract dysfunction in this special population.

scholarly journals Recent Advances in Urinary Tract Reconstruction for Neuropathic Bladder in Children

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 204 ◽  
Author(s):  
Roberto I. Lopes ◽  
Armando Lorenzo
Keyword(s):  
Urinary Tract ◽  
Upper Urinary Tract ◽  
Lower Urinary Tract Dysfunction ◽  
Reconstructive Procedures ◽  
Neuropathic Bladder ◽  
Urinary Tract Reconstruction ◽  
Tract Infections ◽  
Tract Damage ◽  
Lower Urinary

Neuropathic bladder usually causes several limitations to patients’ quality of life, including urinary incontinence, recurrent urinary tract infections, and upper urinary tract damage. Its management has significantly changed over the last few years. The aim of our paper is to address some salient features of recent literature dealing with reconstructive procedures in pediatric and adolescent patients with lower urinary tract dysfunction.

The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines

2007 ◽  
Vol 13 (7) ◽  
pp. 915-928 ◽  
Author(s):  
Marianne de Sèze ◽  
Alain Ruffion ◽  
Pierre Denys ◽  
Pierre-Alain Joseph ◽  
Brigitte Perrouin-Verbe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Urinary Tract ◽  
Neurogenic Bladder ◽  
High Amplitude ◽  
Upper Urinary Tract ◽  
Review Of The Literature ◽  
Indwelling Catheter ◽  
Practical Guidelines

Vesicourethral dysfunction is very frequent in multiple sclerosis (MS) and has functional consequences for patients' quality of life and also an organic impact following complications of the neurogenic bladder on the upper urinary tract. While the functional impact and its management are well documented in the literature, the organic impact remains underestimated and there are no consensual practical guidelines for the screening and prevention of MS neurogenic bladder complications. The aim of this review of the literature, focused on identifying the risk factors of urinary tract complications in MS, is to put forward well informed considerations to help in the definition of practical guidelines for the follow-up of the neurogenic bladder in MS in order to improve its prevention and patient management. Four main risk factors have been identified for upper urinary tract damage: the duration of MS, the presence of an indwelling catheter, high-amplitude neurogenic detrusor contractions and permanent high detrusor pressure. Detrusor-sphincter dyssynergia, age over 50 and male sex may form three additional risk factors. Recommendations for long-term urological follow-up, taking into account these specific risks are constructed according to the procedures recommended by the French Health Authorities. Multiple Sclerosis 2007; 13: 915-928. http://msj.sagepub.com

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