VESICOURETHRAL DYSFUNCTION ASSOCIATED WITH MULTIPLE-SCLEROSIS - CLINICAL AND URODYNAMIC PERSPECTIVES

Purpose: We investigate the association of clinical and urodynamic fin dings with corresponding clinical grade and possible predictors of cli nical grade of multiple sclerosis (MS). Materials and Methods: A total of 90 patients, 28 to 62 years old (mean age 45.8 +/- 12.1), with the clinical syndrome of MS were consecutively and prospectively studied. All patients were subjected to detailed video urodynamic evaluation a nd electromyography of the external urethral sphincter. Results: Urody namic evaluation revealed detrusor hyperreflexia in 52 patients (57.7% ), detrusor external sphincter dyssynergia in 27 (30%) and hypocontrac tility or areflexia of the detrusor in 15 (16.6%). Residual urine vari ed widely from 50 to 900 ml. Decreased compliance with areflexia was s een in 5 patients (5.5%) and nonrelaxing sphincter (but not contractin g) with bladder hypercontractility was noted in 9 (10%). Statistical a nalysis followed comparison of 2 proportions. When patients with a les s severe form (grades 1 and 2) were differentiated from those with a m ore severe form of MS (grade 3), we observed a significant difference only in incontinence, high post-void residual, leg spasticity, urinary stones, hydronephrosis, type 3 detrusor external sphincter dyssynergi a, no electromyography activity and positive sharp waves. The variable s with the highest predictive value between the groups were urinary st ones, sepsis, type 3 detrusor external sphincter dyssynergia and no el ectromyography activity of the external urethral sphincter (100%). Con clusions: Proper identification of the bladder and external urethral s phincter status, especially exclusion of detrusor overactivity or a dy ssynergic response of the external urethral sphincter, will prevent co mplications that may result in deterioration of quality of life.