title: First-line urological evaluation in multiple sclerosis: validation of a specific decision-making algorithm.
abstract: BACKGROUND
  Urinary disorders that lead to urological complications are frequent in multiple sclerosis, resulting in diminished quality of life. Urinary management guidelines are scarce and targeted to neuro-urology specialists.
  
  
  OBJECTIVE
  This study aimed to construct and validate an algorithm dedicated to neurologists and general practitioners to facilitate first-line evaluation and treatment of urinary disorders associated with multiple sclerosis.
  
  
  METHODS
  49 items concerning urological symptom evaluation and therapeutic strategies were derived from literature analysis and evaluated by an expert panel. The Delphi method established consensus between the experts and allowed development of the First-Line Urological Evaluation in Multiple Sclerosis (FLUE-MS) algorithm. Two questions from the Urinary Bothersome Questionnaire in Multiple Sclerosis were included and their validation to verify comprehensiveness and acceptability was also conducted.
  
  
  RESULTS
  Three rounds of expert review obtained consensus of all 49 items and allowed finalisation of the algorithm. Comprehension and acceptability of two Urinary Bothersome Questionnaire in Multiple Sclerosis questions were verified (mean comprehensiveness score: 1.99/2 [99.7% total comprehensiveness], mean acceptability score: 1.99/2 [99.1% complete acceptability]).
  
  
  CONCLUSIONS
  The FLUE-MS algorithm was designed for neurologists and general practitioners, enabling identification of 'red flags', timely patient referral to specialist neuro-urology units, and appropriate first-line therapy.
authors.affiliation: Service de Neuro-Urologie et d'Explorations Périnéales, Hôpital TENON, APHP, France, GREEN UPMC, GRC 01 UPMC.
authors.forename: Gérard
authors.initials: G
authors.lastname: Amarenco
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
authors.forename: Pierre
authors.initials: P
authors.lastname: Denys
authors.forename: Jacques Labat
authors.initials: JL
authors.lastname: Jean
authors.forename: Marianne
authors.initials: M
authors.lastname: de Sèze
authors.forename: Catherine
authors.initials: C
authors.lastname: Lubetzski
mesh_terms: D000465:Algorithms; D017281:Cost of Illness; D003661:Decision Support Techniques; D003697:Delphi Technique; D003950:Diagnostic Techniques, Urological; D058006:General Practice; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications*; D009462:Neurology; D011237:Predictive Value of Tests; D011788:Quality of Life; D012017:Referral and Consultation; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology
keywords: Algorithms; multiple sclerosis; overactive bladder; urinary incontinence; urinary incontinence – urge; urination disorders