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Neurourological assessment in people with multiple sclerosis (MS): a new evaluated algorithm.
Burkhard Domurath1, Ines Kurze2, Ruth Kirschner-Hermanns3
1Neuro-Urological Center, Clinic Beelitz GmbH, Neurological Rehabilitation Clinic, Paracelsusring 6 a, 14547 Beelitz Heilstätten, Germany.
Multiple Sclerosis and Related Disorders
|June 21, 2020
Summary
A new algorithm using four key indicators can help diagnose neurogenic lower urinary tract dysfunction (NULTD) in multiple sclerosis (MS) patients. This simple tool aids in identifying NULTD, often overlooked in routine care.
Area of Science:
- Neurology
- Urology
- Medical Diagnostics
Background:
- Neurogenic lower urinary tract dysfunction (NULTD) is a prevalent complication in multiple sclerosis (MS) patients.
- NULTD is frequently underestimated and undertreated due to patient reluctance, symptom variability, and poor interdisciplinary communication.
- Existing guidelines for NULTD in MS are based on scientific evidence and expert opinion but are underutilized.
Purpose of the Study:
- To develop a straightforward diagnostic algorithm for identifying NULTD in MS patients for routine clinical practice.
- The algorithm aims to facilitate early detection and intervention by identifying key diagnostic parameters and red flags.
- To improve the diagnostic process for NULTD in MS, bridging the gap between neurological and urological care.
Main Methods:
- An interprofessional consensus group developed a diagnostic algorithm for NULTD in MS.
- The algorithm was validated in 121 MS patients using micturition diaries, post-void residual volume, uroflowmetry, and urodynamic studies.
- Logistic regression models and binary classifier performance measures were used for statistical analysis.
Main Results:
- Four parameters effectively diagnosed NULTD: post-void residual urine volume (PVR ≥70 mL), urinary tract infection (UTI) rate (none in 6 months), micturition frequency (>13/day), and incontinence.
- Uroflowmetry also predicted urodynamically measurable bladder dysfunction.
- The developed algorithm demonstrated a high sensitivity of 95% for detecting NULTD.
Conclusions:
- A basic examination to detect NULTD should be standard for all MS patients.
- The study's algorithm, utilizing four easily obtainable parameters, can effectively identify NULTD in MS patients.
- Early detection through this algorithm can lead to timely management and improved patient outcomes.
