Ga. Barbalias et al., VESICOURETHRAL DYSFUNCTION ASSOCIATED WITH MULTIPLE-SCLEROSIS - CLINICAL AND URODYNAMIC PERSPECTIVES, The Journal of urology, 160(1), 1998, pp. 106-111
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.