乌鸦传媒

DALLAS -- Nearly 80% of multiple sclerosis patients in a large registry reported overactive bladder symptoms, and more than one-third of newly diagnosed patients in a different cohort also had urinary dysfunction, researchers reported here.

Analysis of questionnaires returned by 8,380 participants in the registry operated by the indicated that 6,392 of them reported overactive bladder -- including 5,159 who said they had urgency-related leakage, according to , of the University of Alabama at Birmingham, and colleagues.

However, barely half had ever seen a urologist for their symptoms, the researchers reported during a poster session at the joint meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis (CMSC-ACTRIMS).

In part because a recent history of urinary tract infections was relatively common in patients with "wet" overactive bladder -- who had a mean of 0.85 infections in the past 6 months, compared with 0.56 on average among those with "dry" symptoms and 0.47 without any -- Cofield and colleagues suggested that patients with urgency-related leakage "may benefit from more specialty care."

In the study of newly diagnosed patients, , and colleagues at the Tanner Center for MS in Birmingham found that 38% (13 of 34 recruited at initial MS diagnosis) had post-voiding urinary retention (at least 50 mL after urinating) as measured by ultrasound scan.

The same 13 patients all showed some degree of ambulatory impairment as well, with 25-foot walk times greater than the "normal" of 2.2 seconds. Four of these patients had 25-foot walk times in excess of 5 seconds, indicating significant impairment, Riser and colleagues reported.

Cofield and colleagues had also found that other disabilities frequently accompanied the overactive bladder. Moderate to severe overall disability as rated with the 8-point Patient Determined Disease Steps scale was reported by 80.7% of NARCOMS participants with overactive bladder plus leakage, 65.4% of those with overactive bladder but no leakage, and 48.4% of those with no urinary symptoms (P<0.001 for wet overactive bladder versus no symptoms).

Together, the two studies' results confirm that bladder dysfunction is a common feature of MS, even in its earliest stages.

A third study reported at the CMSC-ACTRIMS meeting examined whether routine ultrasound bladder scans would aid in clinical management -- with results suggesting the answer is "hardly ever."

, and colleagues at St. Elizabeth's Hospital in Boston performed scans on 101 consecutive consenting MS patients (70 with relapsing-remitting disease, 31 with primary or secondary progressive MS). Patients were also asked about urination problems such as frequency, urgency, and leakage.

Patients were considered symptomatic if they reported two or more symptoms with at least minimal severity or one symptom of at least moderate severity.

Most symptomatic patients showed normal (less than 50 mL) post-voiding retention with the scans. Of 20 patients deemed asymptomatic, only one (with relapsing-remitting MS) had a positive scan, and the measurement of 51 mL in this patient just barely exceeded the necessary threshold.

"For symptomatic patients, measurement of post-voiding retention did not alter clinical decision-making or provide additional useful information," Lathi and colleagues concluded.

But they stopped short of suggesting that the scans were completely useless. The single asymptomatic patient with a positive scan may represent "a small but meaningful percentage of patients with relapsing-remitting MS, and measurement of post-retention voiding is most valuable for identifying this group," they argued.

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