title: Diagnostic tools for assessment of urinary dysfunction in MS patients without urinary disturbances.
abstract: Many guidelines are available for the management of lower urinary tract symptoms (LUTSs) in multiple sclerosis (MS) patients, but no agreement exists on the best approach for subjects without LUTSs. The objective of this study was to evaluate whether LUTSs can be detected in MS patients asymptomatic for urinary dysfunction, comparing three different tools [measure of post-void residual volume (PRV), bladder diary (BD), a focused questionnaire (IPSS)], and whether disability, disease duration and signs of pyramidal involvement are linked to their subclinical presence. 178 MS patients (118 women) have been included (mean age 41.2 years, mean disease duration 11.3 years, mean EDSS 2.2), and tested with the above-mentioned tools. PRV was abnormal in 14 subjects (7.8%), associated to abnormal findings at IPSS in 3 cases, at BD in 2 cases, at both in 1. BD was abnormal in 37 subjects (20.8%), with concomitant abnormal PRV in 2, abnormal IPSS in 10 cases, abnormal IPSS and BD in 1. IPSS was ≥ 9 in 43 subjects (24.1%). At least one test was abnormal in 76 patients (42.7%): 1 in 57 patients (32.0%), 2 in 17 (9.5%), and 3 tests in 2 (1.1%). Patients with at least one abnormal urinary variable, compared to patients without urinary abnormalities, had a more frequent pyramidal involvement (69.5 vs. 16.8%, χ(2) = 48.6, p < 0.00001), a more frequent occurrence of EDSS ≥2 (83.1 vs. 23.5%, χ(2) = 56.9, p < 0.00001), and a longer disease duration (15.7 ± 7.3 vs. 9.1 ± 7.1, t = 5.7, p < 0.00001). Asymptomatic LUTS were frequent but none of the tests used permitted to better identify asymptomatic patients.
authors.affiliation: Neurologia 2-Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013, Gallarate, Italy. ghezzangelo@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Ghezzi
authors.affiliation: Neurologia 2-Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013, Gallarate, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mutta
authors.affiliation: Divisione di Neurologia, Ospedale S. Raffaele Milano, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bianchi
authors.affiliation: Clinica Neurologica, Università Federico II Napoli, Naples, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bonavita
authors.affiliation: Clinica Neurologica, Università Tor Vergata, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Buttari
authors.affiliation: Clinica Neurologica, Università di Catania, Catania, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Caramma
authors.affiliation: Centro Sclerosi Multipla, IRCCS Don Gnocchi, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Cavarretta
authors.affiliation: Clinica Neurologica, Università Tor Vergata, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Centonze
authors.affiliation: Centro Sclerosi Multipla, Ospedale Binaghi, Cagliari, Italy.
authors.forename: G C
authors.initials: GC
authors.lastname: Coghe
authors.affiliation: Divisione di Neurologia, Ospedale S. Carlo, Matera, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Coniglio
authors.affiliation: Divisione di Neurologia, Ospedale S. Raffaele Milano, Milan, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Del Carro
authors.affiliation: Divisione di Neurologia, Ospedale di Cremona, Cremona, Italy.
authors.forename: M T
authors.initials: MT
authors.lastname: Ferrò
authors.affiliation: Centro Sclerosi Multipla, Ospedale Binaghi, Cagliari, Italy.
authors.forename: M G
authors.initials: MG
authors.lastname: Marrosu
authors.affiliation: Clinica Neurologica, Università di Catania, Catania, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Patti
authors.affiliation: Centro Sclerosi Multipla, IRCCS Don Gnocchi, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rovaris
authors.affiliation: Clinica Neurologica, Università Federico II Napoli, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sparaco
authors.affiliation: Clinica Neurologica, Università di Bari, Bari, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Simone
authors.affiliation: Clinica Neurologica, Università di Bari, Bari, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Tortorella
authors.affiliation: Clinica Neurologica, IRCSS Mondino, Pavia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bergamaschi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D016015:Logistic Models; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000503:physiopathology*; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
keywords: Bladder diary; IPSS; Multiple sclerosis; Post-void residual volume; Urinary dysfunction