Urodynamic findings in primary progressive multiple sclerosis are associated with increased volumes of plaques and atrophy in the central nervous system

Abstract

Objective: Voiding dysfunction is more frequent in primary progressive multiple sclerosis (PPMS) than in other subtypes of MS. We investigated whether lower urinary tract disorders are reflected in the extent of changes in brain and spinal cord detected by magnetic resonance imaging (MRI).

Methods: Micturition symptoms and specific urodynamic findings in 24 patients with PPMS were related to MRI abnormalities as analysed by segmentation and volumetric analysis.

Results: Urgency and urge incontinence were the most frequent urinary symptoms (83 and 75 %), while detrusor sphincter dyssynergia (DSD) (71%), detrusor hyperreflexia (58%) and obstruction (58%) were the most common micturition dysfunctions. Comparison between patients with detrusor hyperreflexia and those with normal bladder function revealed higher volumes of T2-weighted plaques in the brains of former (P = 0.01). In patients with hypotonic bladder the total brain volume was smaller (P = 0.02) and the number of thoracic plaques in T2-weighted images higher (P = 0.02) compared to patients with normal bladder function. Furthermore, DSD was associated with a higher volume of T2-weighted plaques in the brain (P = 0.02).

Conclusions: Voiding dysfunction in PPMS is associated with increasing brain and spinal cord abnormalities. Urodynamic investigation is, however, needed for specific definition of micturition disturbances and should be made before therapeutic decisions.