Urodynamic Voiding Patterns in Multiple Sclerosis

This study aimed to describe urodynamic voiding patterns in patients with MS (PwMS) using standardized assessments, and to compare the performance of the available nomograms and indices for obstruction and bladder contractility.

PwMS and lower urinary tract symptoms underwent cystometry and pressure flow studies. Fluoroscopy findings were collected when available. Bladder contractility was assessed using the following parameters: bladder voiding efficiency (BVE), bladder contractility index (BCI), Watts factor (WF) for men, Projected Isovolumetric Pressure 1 (PIP1), the Valentini-Besson-Nelson (VBN) parameter k, and the urodynamic cut-off proposed by Gammie et al. for women. Obstruction was assessed using the bladder outlet obstruction index (BOOI) in men, and BOOIf in women. Agreement between the diagnosis of detrusor underactivity (DUA) and obstruction according to each parameter was assessed with weight kappa.

Ninety-seven PwMS were included (mean age 48.4 ± 10.5, 58 [60%] women, mean EDSS 3.9 ± 1.8). Sphincter dysfunction was observed in 68 patients (70%), most frequently detrusor sphincter dyssynergia (DSD) in 32 (33%), followed by non-relaxing urethral sphincter in 29 (30%), and delayed relaxation of the urethral sphincter in 7 (7%) PwMS. DUA was found in 22 PwMS (23%). All indices demonstrated low to moderate agreement with the diagnosis of DUA and obstruction in this cohort.

Abnormal voiding patterns are common in PwMS, especially sphincter dysfunction. None of the developed indices for obstruction and DUA appear highly relevant in this specific neurogenic population.