title: High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis.
abstract: Neurogenic lower urinary tract dysfunction (NLUTD) is very common in patients with multiple sclerosis (MS), and it might jeopardize renal function and thereby increase mortality. Although there are well-known urodynamic risk factors for upper urinary tract damage, no clinical prediction parameters are available.
  
  
  
  We aimed to assess clinical parameters potentially predicting urodynamic risk factors for upper urinary tract damage.
  
  
  
  A consecutive series of 141 patients with MS referred from neurologists for primary neuro-urological work-up including urodynamics were prospectively evaluated. Clinical parameters taken into account were age, sex, duration, and clinical course of MS and Expanded Disability Status Scale (EDSS).
  
  
  
  Multivariate modeling revealed EDSS as a clinical parameter significantly associated with urodynamic risk factors for upper urinary tract damage (odds ratio = 1.34, 95% confidence interval (CI) = 1.06-1.71, p = 0.02). Using receiver operator characteristic (ROC) curves, an EDSS of 5.0 as cutoff showed a sensitivity of 86%-87% and a specificity of 52% for at least one urodynamic risk factor for upper urinary tract damage.
  
  
  
  High EDSS is significantly associated with urodynamic risk factors for upper urinary tract damage and allows a risk-dependent stratification in daily neurological clinical practice to identify MS patients requiring further neuro-urological assessment and treatment.
authors.affiliation: Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland/Department of Neurology, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Benjamin V
authors.initials: BV
authors.lastname: Ineichen
authors.affiliation: Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland/Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Schneider
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hlavica
authors.affiliation: Private Statistician, Spiez, Switzerland.
authors.forename: Niels
authors.initials: N
authors.lastname: Hagenbuch
authors.affiliation: Department of Neurology, University Hospital Zürich, Zürich, Switzerland/Department of Neurology, HELIOS-Klinik Hagen-Ambrock, Hagen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Linnebank
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology*; D014551:Urinary Tract / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology*
keywords: Expanded Disability Status Scale (EDSS); Multiple sclerosis (MS); detrusor sphincter dyssynergia (DSD); neuro-urology; neurogenic lower urinary tract dysfunction (NLUTD); overactive bladder; prospective study; vesico-uretero-renal reflux