Vesicourethral dysfunction and urodynamic findings in multiple sclerosis: A study of 149 cases

Autor: Philippe Gallien, Sandrine Robineau, R. Brissot, M Verin, MP Le Bot, Benoit Nicolas
Rok vydání: 1998
Předmět:
Zdroj: Archives of Physical Medicine and Rehabilitation. 79:255-257
ISSN: 0003-9993
DOI: 10.1016/s0003-9993(98)90003-x
Popis: Gallien R Robineau S, Nicolas B, Le Bot M-P, Brissot R, Verin M. Vesicourethral dysfunction and urodynamic findings in multiple sclerosis: a study of 149 cases. Arch Phys Med Rehabil 1998;79:255-257. Objective: Vesicourethral dysfunction is common in people with multiple sclerosis and results in significant impairment. We studied the clinical and urodynamic findings in such patients to define risk factors for incontinence and upper urinary tract infections. Design and Setting: A cohort study of 149 patients with multiple sclerosis and urinary symptoms seen in our urodynamic laboratory. Intervention: A complete urodynarnic study of each patient with urethrocystometry and continuous recording of the urethral sphincter electromyography and assessment of postvoid residual. Results: Detrusor hyperreflexia and sphincter dyssynergia were the main dysfunctions. No significant relation between clinical features and urodynamic patterns was found. Women with low maximal urethral pressure were particularly prone to incontinence, which occurred in 69% of the patients. Pyelonephritis was associated with a postvoiding residual urine of >30% of the functional detrusor capacity, and was found more often in the male population. Conclusion: Urodynamic assessment of bladder function is critical to direct therapy for urinary complaints in people with multiple sclerosis. @ 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation V ES1COURETHRAL DYSFUNCTION is a common finding in patients with multiple sclerosis (MS). Urinary symptoms occur in 50% to 80% of patients and can result in major impairment. Previous reports 1-7 have described several disturbances found during urodynamic investigation: detrusor hyperflexia or hyporeflexia and detrusor sphincter dyssynergia, with a poor correlation with the clinical signs. Although frequency and urgency are often synonymous with de~usor hyperreflexia, these symptoms are sometimes observed in detrnsor hyporeflexia. Pozzilli 8 was unable to find a relation between bladder dysfunction and pathologic findings through magnetic resonance imaging, except in relation to midbrain lesions, which were more common in persons with urinary disorders. This is likely because the micturifion reflex is located in the pontine mesencephalic reticular formation. Pozzilli, however, did not perform cystometry or electromyographic studies of the urethral sphincter to support these observations. In our study of 149 patients with MS, the relation between urinary symptoms and urodynamic patterns was investigated. Thus, we have defined risk factors for urinary infection and incontinence to improve the management of these complications. MATERIALS AND METHODS The 149 patients were referred to our urodynamic laboratory between 1990 and 1995. All had marked urinary symptoms that justified urodynamic investigation. Fifty-four were men and 95 were women. The mean age at the time of examination was 46.7 ± 11 years, and the mean duration of MS was 13 years. Patient characteristics are listed in table 1. Forty-two patients had urinary problems as a part of the initial symptoms of the MS. Fourteen could not specify when the urinary problems began. In all cases, the diagnosis of MS was made by a neurologist from clinical features and investigatory results. Patients were evaluated for overall disability using the Expanded Disability Status Scale (EDSS). 9 A complete urologic record was obtained from all patients, with special emphasis on the onset and progression of symptoms and the results of any previous investigation. All complications were well documented. A urodynamic investigation was done for each patient. The examination consisted of simultaneous measurement of intravesical, intraurethral, and intraabdorninal pressures at a filling rate of 50mL/min of isotonic saline. Urethral sphincter electromyography with a coaxial needle was systematically done with a continuous recording. Bladder dysfunction was classified as either detrusor hyperreflexia or detrusor hyporeflexia. Detrusor hyporeflexia included at least 2 of the following 3 presenting characteristics: poor subjective sensation of bladder events, bladder areflexia or detrusor contractility of 600mL. The criteria for hyperreflexia were bladder capacity of 15cm of water during filling. The following data obtained from clinical and urodynarnic From Clinique de RrEducation Fonctionelle (Drs, Gallien, Robineau, Nicolas, Le Bot, Brissot) and Service de Neurologie (Dr. Verin), Centre Hospitalier et Universitaire de Rennes, Hrpital Pontchaillou, Renne, France. Submitted for publication February 21, 1997. Accepted in revised form June 30, 1997. No commercial party having a direct or indirect interest in the subject matter of this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. Reprint requests to Philippe Gallien, MD, Clinique de R66ducation Fonctionelle, Centre Hospitalier et Universitaire de Rennes, Hrpital Pontchaillou, 2 rue Henri Le Gnilloux, 35 033 Rennes cedex, France. @ 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation 0003-9993/98/7903-440653.00/0 Table 1: Patient Characteristics Total Men Women Population Age (yrs) 44 _+ 10 48.1 ± 12.7 46.6 + 12 Age at beginning of MS (yrs) 31.6 -+ 9.5 33.8 ± 9.7 33 ± 9 Age at beginn ing of urinary t rouble (yrs) 36.6 ± 9 40.6 ± 12 39 ± 11
Databáze: OpenAIRE
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