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      Lower urinary tract disorders in multiple sclerosis patients: prevalence, clinical features, and response to treatments

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          Abstract

          Aims

          Lower urinary tract symptoms are common in multiple sclerosis (MS) and have a great impact on quality of life. We evaluated prevalence and characteristics of urological symptoms in a cohort of patients with MS.

          Methods

          This is a cross‐sectional study conducted on consecutive patients with MS attending our Center in 2018. We evaluated prevalence, clinical features, and response to symptomatic treatments of lower urinary tract disorders; we investigated the relationship between them and clinical and demographic features. Data of urodynamic studies were also collected.

          Results

          In our cohort of 806 patients, the overall prevalence of urological symptoms was 52.9% and urgency was the most frequent symptom (59.4%). Symptomatic patients had a higher disability, a longer disease duration, a later age at onset, and a greater mean age at the time of evaluation. Urinary disorders were more frequent in patients with progressive disease and in women. About 41.8% of patients were under treatment for the urological disorder and 81.5% of them reported an improvement of symptoms.

          Conclusion

          Urinary disorders in patients with MS have a high prevalence. An early and correct characterization of types of symptoms and an early and targeted therapeutic strategy are essential to improve the patient's quality of life and avoid future complications.

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          Most cited references25

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          Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).

          J. Kurtzke (1983)
          One method of evaluating the degree of neurologic impairment in MS has been the combination of grades (0 = normal to 5 or 6 = maximal impairment) within 8 Functional Systems (FS) and an overall Disability Status Scale (DSS) that had steps from 0 (normal) to 10 (death due to MS). A new Expanded Disability Status Scale (EDSS) is presented, with each of the former steps (1,2,3 . . . 9) now divided into two (1.0, 1.5, 2.0 . . . 9.5). The lower portion is obligatorily defined by Functional System grades. The FS are Pyramidal, Cerebellar, Brain Stem, Sensory, Bowel & Bladder, Visual, Cerebral, and Other; the Sensory and Bowel & Bladder Systems have been revised. Patterns of FS and relations of FS by type and grade to the DSS are demonstrated.
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            Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria

            New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use. Ann Neurol 2011
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              The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery.

              To define the prevalence of pelvic floor disorders in a non-institutionalised community and to determine the relationship to gender, age, parity and mode of delivery. A representative population survey using the 1998 South Australian Health Omnibus Survey. Random selection of 4400 households; 3010 interviews were conducted in the respondents' homes by trained female interviewers. This cross sectional survey included men and women aged 15-97 years. The prevalence of all types of self-reported urinary incontinence in men was 4.4% and in women was 35.3% (P 20 weeks), regardless of the mode of delivery, greatly increased the prevalence of major pelvic floor dysfunction, defined as any type of incontinence, symptoms of prolapse or previous pelvic floor surgery. Multivariate logistic regression showed that, compared with nulliparity, pelvic floor dysfunction was significantly associated with caesarean section (OR 2.5, 95% CI 1.5-4.3), spontaneous vaginal delivery (OR 3.4, 95% CI 2.4-4.9) and at least one instrumental delivery (OR 4.3, 95% CI 2.8-6.6). The difference between caesarean and instrumental delivery was significant (P<0.03) but was not for caesarean and spontaneous delivery. Other associations with pelvic floor morbidity were age, body mass index, coughing, osteoporosis, arthritis and reduced quality of life scores. Symptoms of haemorrhoids also increased with age and parity and were reported in 19.9% of men and 30.2% of women. Pelvic floor disorders are very common and are strongly associated with female gender, ageing, pregnancy, parity and instrumental delivery. Caesarean delivery is not associated with a significant reduction in long term pelvic floor morbidity compared with spontaneous vaginal delivery.
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                Author and article information

                Contributors
                viviana.nociti@policlinicogemelli.it
                Journal
                Neurourol Urodyn
                Neurourol Urodyn
                10.1002/(ISSN)1520-6777
                NAU
                Neurourology and Urodynamics
                John Wiley and Sons Inc. (Hoboken )
                0733-2467
                1520-6777
                03 June 2021
                August 2021
                : 40
                : 6 ( doiID: 10.1002/nau.v40.6 )
                : 1500-1508
                Affiliations
                [ 1 ] Department of Ageing, Neurosciences, Head‐neck and Orthopaedics Sciences, Institute of Neurology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS Università Cattolica del Sacro Cuore Rome Italy
                [ 2 ] Department of Woman and Child Health and Public Health Sciences, Urogynecology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS Università Cattolica del Sacro Cuore Rome Italy
                [ 3 ] Department of Medical and Surgical Sciences, Urological Clinic, Fondazione Policlinico Universitario “A. Gemelli” IRCCS Università Cattolica del Sacro Cuore Rome Italy
                Author notes
                [*] [* ] Correspondence Viviana Nociti, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy.

                Email: viviana.nociti@ 123456policlinicogemelli.it

                Author information
                http://orcid.org/0000-0002-4607-3948
                Article
                NAU24687
                10.1002/nau.24687
                8361667
                34082481
                83fb3784-efaf-4b60-99e8-a1a7d52c5995
                © 2021 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 07 March 2021
                : 01 February 2021
                Page count
                Figures: 0, Tables: 5, Pages: 9, Words: 4780
                Categories
                Original Clinical Article
                Original Clinical Articles
                Custom metadata
                2.0
                August 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.5 mode:remove_FC converted:13.08.2021

                Urology
                multiple sclerosis,symptomatic treatments,urinary disorders,urodynamic study
                Urology
                multiple sclerosis, symptomatic treatments, urinary disorders, urodynamic study

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