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Neurogenic Lower Urinary Tract Dysfunction in Women With Multiple Sclerosis
Kruti Patel1, Amy Yan1, Alejandra Cacheiro2
1University of California, Irvine School of Medicine.
Importance:
Women with multiple sclerosis (MS) commonly experience neurogenic lower urinary tract dysfunction (NLUTD) and pelvic floor disorders (PFDs) such as recurrent urinary tract infections (rUTIs) and sexual dysfunction. However, many patients report that NLUTD and sexual dysfunction are not addressed during routine MS care.
Objectives:
The objectives of this study were to describe experiences of women with MS and NLUTD, identify barriers to care, and highlight areas for improvement.
Study Design:
We conducted a mixed-methods study consisting of validated patient-reported outcome measures and semistructured qualitative interviews. English-speaking female patients 18 years and older with MS and NLUTD were recruited at routine neurology visits and stratified by time since MS diagnosis in years (MS diagnosis of <5years, MS diagnosis of 5-10 years, and MS diagnosis of 10+ years). Participants completed 3 validated questionnaires: (1) 36-item Short Form Survey (SF-36), (2) Bladder Control Scale (BCS), and (3) Sexual Satisfaction Survey (SSS). Participants also completed semistructured interviews. Responses were analyzed using paired t tests with a 95% CI. Transcripts were analyzed by 2 independent researchers.
Results:
Eighteen participants were enrolled (mean age 55.4±10.9). In total, 83.3% (n=15) of participants had urinary urgency, and 55.6% (n=10) had frequency. In total, 38.9% (n=7) of patients had rUTIs and 16.7% (n=3) had stress urinary incontinence. Patients with an MS diagnosis of <5 years reported higher SF-36 scores across most domains. BCS scores were highest in the MS diagnosis of 10+ years cohort (12.38±7.75), while SSS scores were highest in the MS diagnosis of 5-10 years cohort (15.40±5.08). Qualitative themes included normalization of NLUTD and PFDs, delays in diagnosis and care, and substantial effects on quality of life.
Conclusions:
Women with MS and NLUTD face unmet needs in routine care. Key areas for improvement include routine screening for urinary dysfunction, encouraging health care provider-initiated discussions, and strengthening patient education.
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