Jaekel Anke K, Winterhagen Franziska I, Zeller Federico L, Butscher Anna-Lena, Knappe Franziska K, Schmitz Franziska, Hauk Christopher, Stein Johannes, Kirschner-Hermanns Ruth K M, Knüpfer Stephanie C
Department for Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany.
Neuro-Urology, Johanniter Neurological Rehabilitation Center 'Godeshoehe e.V.', 53177 Bonn, Germany.
Biomedicines. 2022 Dec 15;10(12):3260. doi: 10.3390/biomedicines10123260.
Neurogenic lower urinary tract dysfunction (NLUTD) in asymptomatic patients with MS has been described in preliminary studies, but specific investigations of this topic are rare. Many authors advise early diagnosis and treatment of NLUTD in patients with MS. In contrast, clinical practice and different guidelines recommend neuro-urological diagnostics only in the presence of symptoms. Our aim was to investigate the characteristics of NLUTD and the correlations of clinical parameters with NLUTD in asymptomatic patients with MS. We evaluated bladder diaries, urodynamic findings, and therapy proposals. Correlations of the voided volume, voiding frequency, urinary tract infections, and uroflowmetry including post-void residual with the urodynamic findings were determined. In our study, 26% of the patients were asymptomatic. Of these, 73.7% had urodynamic findings indicative of NLUTD, 21.1% had detrusor overactivity, 13.2% had detrusor underactivity, 13.2% detrusor overactivity and detrusor sphincter dyssynergia, and 57.9% had radiologically abnormal findings of the bladder. No patients presented low bladder compliance or renal reflux. Clinical parameters from the bladder diary and urinary tract infections were found to be correlated with NLUTD, and the absence of symptoms did not exclude NLUTD in patients with MS. We observed that urinary tract damage is already present in a relevant proportion. Based on our results, we recommend that patients with MS be screened for NLUTD regardless of the subjective presence of urinary symptoms or the disease stage.
无症状多发性硬化症患者的神经源性下尿路功能障碍（NLUTD）在初步研究中已有描述，但针对该主题的具体研究较少。许多作者建议对多发性硬化症患者的NLUTD进行早期诊断和治疗。相比之下，临床实践和不同的指南仅建议在出现症状时进行神经泌尿学诊断。我们的目的是研究无症状多发性硬化症患者NLUTD的特征以及临床参数与NLUTD的相关性。我们评估了膀胱日记、尿动力学检查结果和治疗建议。确定了排尿量、排尿频率、尿路感染以及包括排尿后残余尿量在内的尿流率与尿动力学检查结果之间的相关性。在我们的研究中，26%的患者无症状。其中，73.7%的患者有提示NLUTD的尿动力学检查结果，21.1%有逼尿肌过度活动，13.2%有逼尿肌活动低下，13.2%有逼尿肌过度活动和逼尿肌括约肌协同失调，57.9%有膀胱影像学异常表现。没有患者出现膀胱顺应性降低或肾反流。发现膀胱日记中的临床参数和尿路感染与NLUTD相关，并且无症状并不排除多发性硬化症患者存在NLUTD。我们观察到相当比例的患者已经存在尿路损害。基于我们的研究结果，我们建议无论患者主观上是否存在泌尿系统症状或疾病处于何阶段，均应对多发性硬化症患者进行NLUTD筛查。
