Viart L, Elalouf V, Petit J, Al Khedr A, Kristkowiak P, Saint F
Services d'urologie-transplantation, CHU Amiens Sud, Salouel cedex, France.
Prog Urol. 2012 Dec;22(16):1026-32. doi: 10.1016/j.purol.2012.08.271. Epub 2012 Sep 16.
Urinary symptoms occur in 50 to 80% of patients with Multiple Sclerosis (MS). This study was conducted to determine prevalence of renal failure during MS follow-up and to investigate the correlation of these complications with disease characteristics and urodynamic findings.
One hundred and twenty-one consecutive patients have been followed for (MS) (61 men and 60 women) between 1995 and 2009 in our institution. The demographic findings of patients were documented. The history was obtained and a detailed neurological and urological physical examination was performed for all patients. Urological symptoms (urgency, frequency, urge incontinence, dysuria), urinary scores (UPS and International Consultation on Incontinence Questionnaire [ICIQ]) and renal failure were recorded. All patients underwent ultrasound imaging of the bladder during their follow-up and on the last evaluation. Expanded Disability Status Scale (EDSS) was evaluated during neurologic follow-up. For each patient mean onset age of disease, mean onset age of micturation disorders, mean illness duration and mean urological follow-up duration were recorded. Urodynamic investigation was performed for all patients. Urodynamic assessment was carried out according to the International Continence Society (ICS) standards (detrusor overactivity, detrusor/sphincteric dyssynergia and low bladder compliance).
Mean illness duration was 13.8 years (1-50). According to the history and clinical findings, 21 patients had primary-progressive (PPMS), 59 relapsing-remitting (RRMS) and 41 secondary-progressive multiple sclerosis (SPMS). Four patients have shown renal failure during their follow-up (3.3% - three men and one woman). Renal failure was associated with disease characteristic (SPMS - EDSS score >6.5), mean illness duration (30 years [12-48]) and low bladder compliance (17 [7-23]) (P=0.03; P=0.02; P=0.049).
Relationship between renal failure, disease characteristics and urodynamic findings was suggested in our study. More accurate follow-up might be used for SPMS (EDSS >6.5), longer mean illness duration (>30 years), and low bladder compliance (<30).
50%至80%的多发性硬化症（MS）患者会出现泌尿症状。本研究旨在确定MS随访期间肾衰竭的患病率，并调查这些并发症与疾病特征及尿动力学检查结果之间的相关性。
1995年至2009年期间，我们机构对121例连续的MS患者（61例男性和60例女性）进行了随访。记录患者的人口统计学数据。获取病史，并对所有患者进行详细的神经和泌尿外科体格检查。记录泌尿症状（尿急、尿频、急迫性尿失禁、排尿困难）、泌尿评分（UPS和国际尿失禁咨询问卷[ICIQ]）以及肾衰竭情况。所有患者在随访期间及最后一次评估时均接受膀胱超声检查。在神经科随访期间评估扩展残疾状态量表（EDSS）。记录每位患者的疾病平均发病年龄、排尿障碍平均发病年龄、平均病程和平均泌尿外科随访时间。对所有患者进行尿动力学检查。根据国际尿失禁学会（ICS）标准（逼尿肌过度活动、逼尿肌/括约肌协同失调和膀胱顺应性降低）进行尿动力学评估。
平均病程为13.8年（1至50年）。根据病史和临床表现，21例患者为原发进展型（PPMS），59例为复发缓解型（RRMS），41例为继发进展型多发性硬化症（SPMS）。4例患者在随访期间出现肾衰竭（3.3%——3例男性和1例女性）。肾衰竭与疾病特征（SPMS——EDSS评分>6.5）、平均病程（30年[12至48年]）和膀胱顺应性降低（17[7至23]）相关（P = 0.03；P = 0.02；P = 0.049）。
我们的研究提示了肾衰竭、疾病特征和尿动力学检查结果之间的关系。对于SPMS（EDSS>6.5）、平均病程较长（>30年）和膀胱顺应性降低（<30）的患者，可能需要更精确的随访。
