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[Clinical and urodynamic risk factors of recurrent urinary tract infections in patients with multiple sclerosis.]
Jesús Salinas-Casado1, Miguel Vírseda-Chamorro2, Santiago Méndez-Rubio3
1Servicio de Urología. Hospital Clínico San Carlos. Madrid. España.
Objectives:
To determine the risk factors of recurrent urinary infections (rUTIs) in patients with Multiple Sclerosis (MS).
Methods:
A retrospective cohort study was conducted including 114 patients with MS, 84 women (74%) and 30 men (26%), with a mean age of 49. They underwent videourodynamic study and selective sphincter electromyography due to urinary symptoms (LUTS). Clinical data (both neurological and urological) and videourodynamic data (including free flowmetry, cystomanometry and pressure flow study) were collected. In 37 patients (32%), the presence of rTUIs was demonstrated.
Results:
Statistically significant differences were demonstrated between the patients with and without rUTIs with respect to the following clinical variables: the time of evolution of the symptoms (greater in the case of rUTIs), time from the diagnosis of MS (higher in the case of rUTIs), EDSS score (Expanded Disability Staus Scale) (higher in the case of rUTIs) and the EM type [higher frequency of rUTIs in the progressive types (primary and secondary)]. Urodynamic variables with significant differences were: maximum flow in free flowmetry (lower in patients with rUTIs), voiding volume in free flowmetry (lower in patients with rUTIs), micturition efficiency (higher percentage of residual urine in patients with rUTIs), stress urinary incontinence (SUI) (higher frequency of rUTIs in patients with SUI), detrusor pressure at maximum flow (lower in patients with rUTIs) and bladder contractility index (lower in patients with rUTI). No significant difference was demonstrated in relation to the presence and type of neurogenic lower urinary tract dysfunction (NLUTD).
Conclusions:
The severity and duration of MS is a risk factor for rUTIs. Urodynamic risk factors are compatible with a lower contractile capacity in patients with rUTIs, while the existence of NLUTD would not imply any specific risk factor.
Insights
The severity and duration of Multiple Sclerosis (MS) increase the risk of recurrent urinary tract infections (rUTIs). Lower bladder contractility, not neurogenic lower urinary tract dysfunction, is associated with rUTIs in MS patients.
Area of Science:
- Neurology
- Urology
- Infectious Diseases
Background:
- Recurrent urinary tract infections (rUTIs) are a common complication in patients with Multiple Sclerosis (MS).
- Understanding the risk factors for rUTIs in MS is crucial for effective management and prevention.
- Previous studies have explored various factors, but a comprehensive analysis combining clinical and urodynamic data is needed.
Purpose of the Study:
- To identify clinical and urodynamic risk factors associated with recurrent urinary tract infections (rUTIs) in patients diagnosed with Multiple Sclerosis (MS).
Main Methods:
- A retrospective cohort study involving 114 MS patients (84 women, 30 men) with a mean age of 49.
- Data collected included clinical (neurological, urological) and videourodynamic parameters (free flowmetry, cystomanometry, pressure flow study).
- Selective sphincter electromyography was performed in patients presenting with lower urinary tract symptoms (LUTS).
Main Results:
- Longer MS duration, higher EDSS scores, and progressive MS types were significantly associated with increased rUTI risk.
- Urodynamic findings indicated lower maximum flow, lower voiding volume, and higher residual urine (indicating reduced micturition efficiency) in patients with rUTIs.
- Stress urinary incontinence (SUI) was more frequent in patients experiencing rUTIs, while detrusor pressure and bladder contractility index were lower.
Conclusions:
- The duration and severity of Multiple Sclerosis are significant risk factors for developing recurrent urinary tract infections.
- Urodynamic evidence suggests that reduced bladder contractile capacity is linked to rUTIs in MS patients.
- The presence of neurogenic lower urinary tract dysfunction (NLUTD) itself did not emerge as a specific risk factor for rUTIs in this cohort.
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