Specificity of Lower Urinary Tract Symptoms in Neuromyelitis Optica in Comparison With Multiple Sclerosis Patients

Purpose The aim of this study was to describe lower urinary tract symptoms in neuromyelitis optica (NMO), and to compare these data with urinary disorders observed in multiple sclerosis (MS) patients. Methods Retrospective study of data collected from January 1997 to July 2017 using the database from a Neuro-Urology Department of a university hospital. NMO and MS patients were matched for sex, age, and Expanded Disability Status Scale (EDSS) Results Twenty-six patients with NMO were included and compared with 33 MS patients. Mean age was 41.6 years (standard deviation [SD], 14,8), mostly female patients (24 vs. 2 males). Mean EDSS was 4.6 (SD, 1.8) in the 2 groups. In NMO group, 57% of the patients (n=15) had overactive bladder with urgency and urge incontinence and 38.5% (n=10) of them had nocturia. Voiding symptoms was observed in 69.2% of the patients (n=18); 42.3% of NMO patients performed self-intermittent catheterization versus 12.1% in MS patients (P=0.012). Low bladder compliance and severe urinary tract infections (pyelonephritis) were more frequent in NMO than in MS patients (respectively 15% vs. 0%, P=0.016 and 42% vs. 12%, P=0.024). Conclusions Lower urinary tract symptoms, especially overactive bladder and urinary retention, are frequent in NMO. Low bladder compliance, serious urinary infections, and high prevalence of urinary retention requiring self-intermittent catheterization are the main symptoms significantly more frequent than in MS

Adherence to Anticholinergic Therapy and Clean Intermittent Self-Catheterization in Patients With Multiple Sclerosis

International audiencePurposeTo evaluate adherence to anticholinergic therapy (AT) and clean intermittent self-catheterization (CISC) in patients with multiple sclerosis (MS) and to identify factors associated with poor adherence.MethodsThis single-center study prospectively included 49 patients suffering from MS who had been prescribed AT and/or CISC. Adherence was evaluated using a self-report questionnaire. The Expanded Disability Status Scale (EDSS), Patient Global Impression of Improvement, Mini-Mental State Examination, Urinary Symptom Profile, and Hospital Anxiety and Depression (HAD) instruments were administered, and the number of daily anticholinergic pills and/or catheterizations was noted. Whether patients were receiving concomitant intradetrusor botulinum toxin injections was assessed, as were barriers to treatment, side effects, number of spontaneous micturitions, reasons for the prescription, satisfaction, and difficulties.ResultsOnly 38% of patients were adherent to AT. Experiencing side effects was related to nonadherence (P=0.02). Only 29% of patients were adherent to CISC. More intense voiding dysfunction (P<0.001), a higher frequency of CISC (P=0.03), and a higher EDSS score (P=0.02) were associated with better adherence. Conversely, the HAD score (P<0.001), depression (P<0.001), the persistence of spontaneous micturition (P<0.001), a blocking sensation during catheterization (P=0.04), and the need to adapt one’s posture or gesture to perform catheterization (P=0.04) were associated with poorer adherence.ConclusionsAdherence to AT and CISC was poor in patients with MS suffering from bladder dysfunction. Several factors related to nonadherence were identified in this study, and addressing these factors might help to improve treatment adherence

Lower Urinary Tract Symptoms in Elderly Population With Multiple Sclerosis

Purpose The aim of this study is to compare the clinical and urodynamic characteristics of urinary disorders in multiple sclerosis (MS) patients in a geriatric population with a nongeriatric population. Methods This study was conducted retrospectively between 2010 and 2016. Each patient with MS aged 65 and older was matched with 2 patients with MS aged less than 65 in sex, form of MS, and Expended Disability Status Scale (EDSS). Demographic data, urinary symptoms, treatment, quality of life, repercussion of lower urinary tract symptoms on daily life activities and psychological state and urodynamic parameters were collected. Differences between the 2 populations were evaluated using Student test, chi-square, or Fischer tests. Results Twenty-four patients with MS aged 65 and older (mean age, 69.8 years) were matched with 48 patients aged less than 65 years (mean age, 49.4 years). Maximum urethral closure pressure was lower in the elderly population than in the nongeriatric population (mean±standard deviation [SD]: 35.6±18.5 cm H2O vs. 78.2±52.3 cm H2O, P<0.001). In the male population, there was no statistical difference in any other clinical or urodynamic endpoints. In the female population, voiding symptoms was more described in the nongeriatric population (Urinary Symptom Profile low stream: 3.4±3.5 vs. 1.7±2.4, P=0.04), geriatric population had less urinary treatment (P=0.05). LUTS had less impact on quality of life (Qualiveen: 1.4±1.0 vs. 2.1±0.9, P=0.02) on the geriatric population than in the nongeriatric of female MS patients. Conclusions Geriatric population of MS has few differences of urinary disorders compared to a nongeriatric population with EDSS, sex, and MS form equal. However, the psychological impact of these urinary disorders is less important in female geriatric population

Auto-sondages intermittents et rétentions urinaires des syndromes parkinsoniens

International audienceINTRODUCTION: Lower urinary tract symptoms are common in Parkinson diseases, especially chronic urinary retention. In case of significant and symptomatic postvoid residual, a specific treatment is necessary in order to empty the bladder and nowadays the gold standard of such neurogenic bladder is based on self-intermittent-catheterizations, if possible at all. We carried out a retrospective study about feasibility and outcomes of self-intermittent-catheterizations in this population.METHODS: Retrospective study with qualitative and quantitative, clinical and instrumental (urodynamic) assessment, of lower urinary tract symptoms as urinary retention in extrapyramidal syndromes.RESULTS: Overall, 42 patients with parkinsonian syndrome performing self-intermittent-catheterization were assessed. Twenty-one had idiopathic Parkinson's disease, 17 multiple system atrophy, 1 vascular Parkinson, 1 iatrogenic Parkinson and 2 not yet determined parkinsonian syndromes. All the patients had urinary retention characterized by a postvoiding residual volume more than 150mL. All the patients were symptomatic and reported voiding dysfunction (30/42), overactive bladder syndrome (20/42), stress urinary incontinence (6/42). The cystometry showed detrusor overactivity (15/42), bladder-sphincter dyssynergia (15/42), detrusor underactivity (14/42), sphincter deficiency (4/42) or bladder compliance alteration (3/42). Each patient have learned and well controlled self-intermittent-catheterization technique. Fourteen (33%) stopped self-intermittent-catheterization prematurely in the following months because of functional impact of neurological worsening.CONCLUSION: Even if one third of the patients had stopped self-intermittent-catheterization because of neurological deterioration, this technique remains the gold standard for the treatment of urinary chronic retention in parkinsonian patients.Introduction: Les troubles vésicosphinctériens sont fréquents dans les syndromes parkinsoniens, notamment la rétention urinaire chronique. En cas de résidu significatif et symptomatique se pose le problème de son traitement qui se résume le plus souvent à la faisabilité ou non de la pratique des auto-sondages intermittents. Nous avons conduit une étude rétrospective sur la faisabilité et les résultats des auto-sondages dans cette population.Méthodes: Étude rétrospective avec analyse qualitative et quantitative, clinique et instrumentale (urodynamique), des troubles vésicosphinctériens à type de rétention au cours des syndromes extrapyramidaux.Résultats: Au total, 42 patients avec syndrome parkinsonien et réalisant des auto-sondages intermittents ont été examinés. Vingt et un étaient atteints d’une maladie de Parkinson idiopathique, 17 d’une atrophie multisystématisée, 1 d’un syndrome parkinsonien d’origine vasculaire, 1 d’un syndrome parkinsonien d’origine iatrogène et 2 d’un syndrome extrapyramidal non étiqueté. Tous avaient une rétention d’urine définie par un résidu post-mictionnel supérieur ou égal à cent cinquante millilitres. Tous étaient symptomatiques et les symptômes rapportés étaient une dysurie (30/42), une hyperactivité vésicale (20/42) et une incontinence urinaire d’effort (6/42). La cystomanométrie mettait en évidence une hyperactivité détrusorienne (15/42), une dyssynergie vésicosphinctérienne (15/42), une hypocontractilité détrusorienne (14/42), une incompétence sphinctérienne (4/42) ou un défaut de compliance (3/42). Tous les patients maîtrisaient la technique des auto-sondages intermittents. Quatorze (33 %) ont arrêté l’auto-sondage précocement dans les mois qui suivaient l’apprentissage en raison du retentissement fonctionnel de la dégradation neurologique.Conclusion: Même si un tiers des patients abandonnent la réalisation des auto-sondages en raison de l’aggravation de la maladie neurologique, ces derniers restent la méthode de choix du traitement symptomatique de la rétention chronique du patient parkinsonien