Domurath Burkhard, Kurze Ines, Kirschner-Hermanns Ruth, Kaufmann Albert, Feneberg Wolfgang, Schmidt Paul, Henze Thomas, Flachenecker Peter, Brandt Anna, Vance Will Nelson, Beck Janina, Vonthien Manuela, Ratering Kerstin
Neuro-Urological Center, Clinic Beelitz GmbH, Neurological Rehabilitation Clinic, Paracelsusring 6 a, 14547 Beelitz Heilstätten, Germany.
Spinal Cord Injury Center, Clinic for Paraplegiologia and Neuro-Urology Robert-Koch-Allee 9, 99438 Bad Berka, Germany.
Mult Scler Relat Disord. 2020 Sep;44:102248. doi: 10.1016/j.msard.2020.102248. Epub 2020 May 30.
Neurogenic lower urinary tract dysfunction (NULTD) is common in patients with multiple sclerosis (MS); nevertheless, it is often underestimated, underdiagnosed, and undertreated due to patients' sense of shame, variability of symptoms, as well as lack of communication between neurologists and urologists, despite the availability of several guidelines based on scientific evidence and expert opinion.
This study was conducted to develop an easy-to-perform algorithm for diagnosing neurogenic lower urinary tract disease in patients with MS for daily neurological and urological routine, including the identification of red flags.
In consensus group meetings, interprofessional experts (neurologists, urologists, neurourologists, nurses, nurse practitioners, occupational therapists, physical therapists as well as representatives of national MS centers, self-care groups, social care, residential care, and health-aid-providers) developed a diagnostic algorithm to detect NULTD in patients with MS. Subsequently, the group evaluated the algorithm in 121 patients with MS using micturition diary, post-void residual volume, uroflowmetry, and urodynamic studies. Statistical analysis was conducted on the basis of logistic regression models to compare patients with normal and abnormal urodynamic examinations. Differentiation was performed using selected diagnostic parameters as well as standard performance measures for binary classifiers to assess prognostic quality.
The following four parameters allowed to diagnose NLUTD in patients with MS: post-void residual urine volume, rate of urinary tract infections during the past 6 months, micturition frequency, and incontinence. According to statistical analysis, the following thresholds could be defined: post-void residual volume (PVR) ≥70 mL (Odds Ratio (OR) = 1.24; 95% CI:[1.07,1.62]), urinary tract infection (UTI) rate - none in 6 months (OR = 2.03; 95% CI:[1.04,6.68]), and micturition frequency >13/day, standardized on 2000 mL urine excretion (OR = 1.24; 95% CI:[1.07,1.49]). Uroflowmetry served as a further predictor of urodynamically measurable urinary bladder dysfunction (OR = 4.80; 95% CI: [1.41, 19.21]). Interestingly, patients without any complaints of NLUTD had an abnormal urodynamic examination in >50% of the cases. The entire algorithm has a sensitivity of 95%.
All patients with MS should undergo a basic examination to detect NLUTDs. Within the algorithm developed in this study, four easy-to-collect parameters may reveal NLUTD in patients with MS.
神经源性下尿路功能障碍（NULTD）在多发性硬化症（MS）患者中很常见；然而，由于患者的羞耻感、症状的变异性，以及神经科医生和泌尿科医生之间缺乏沟通，尽管有基于科学证据和专家意见的多项指南，但该病常常被低估、漏诊和治疗不足。
本研究旨在开发一种易于执行的算法，用于在日常神经科和泌尿科诊疗中诊断MS患者的神经源性下尿路疾病，包括识别警示信号。
在多专业专家共识会议上（神经科医生、泌尿科医生、神经泌尿科医生、护士、执业护士、职业治疗师、物理治疗师以及国家MS中心、自我护理团体、社会护理、住宿护理和健康援助提供者的代表），制定了一种诊断算法，以检测MS患者的NULTD。随后，该小组使用排尿日记、排尿后残余尿量、尿流率和尿动力学研究对121例MS患者的算法进行了评估。基于逻辑回归模型进行统计分析，以比较尿动力学检查正常和异常的患者。使用选定的诊断参数以及二元分类器的标准性能指标进行区分，以评估预后质量。
以下四个参数可用于诊断MS患者的NLUTD：排尿后残余尿量、过去6个月内的尿路感染率、排尿频率和尿失禁。根据统计分析，可定义以下阈值：排尿后残余尿量（PVR）≥70 mL（优势比（OR）=1.24；95%置信区间：[1.07,1.62]），尿路感染（UTI）率——6个月内无感染（OR = 2.03；95%置信区间：[1.04,6.68]），以及排尿频率>13次/天（以2000 mL尿量排泄为标准）（OR = 1.24；95%置信区间：[1.07,1.49]）。尿流率可作为尿动力学可测量的膀胱功能障碍的进一步预测指标（OR = 4.80；95%置信区间：[1.41,19.21]）。有趣的是，没有任何NLUTD主诉的患者中，超过50%的病例尿动力学检查异常。整个算法的敏感性为95%。
所有MS患者均应接受基本检查以检测NLUTD。在本研究开发的算法中，四个易于收集的参数可能揭示MS患者的NLUTD。
