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Nocturnal Urinary Disorders and Multiple Sclerosis: Clinical and Urodynamic Study of 309 Patients
Mauruc E et al.
The Journal of Urology, Volume 197, Issue 2, February 2017, Pages 432–437
Commentary by Philip Van Kerrebroeck
In this analysis the authors describe nocturia with or without leakage in a specific population of patients with multiple sclerosis. Unfortunately it is a retrospective, single centre study, but consists of 309 patients with multiple sclerosis who were followed at an experienced Neuro-Urology centre between 2011 and 2013. All patients had daytime urinary symptoms associated with the disorder, but the whole group the patients was divided into 2 subgroups: those with isolated nocturia but without nocturnal urinary incontinence and patients with nocturia associated with nocturnal urinary incontinence. The control group comprised of patients without nocturia. The clinical variables and urodynamic data studied were gender, age, EDSS (Expanded Disability Status Scale), the USP (Urinary Symptoms Profile) questionnaire overactive bladder score, bladder capacity, detrusor activity and volume at the first detrusor contraction. Of the total group of patients with MS, 53.3% had nocturia, including 35.7% with nocturnal urinary incontinence. The average SD USP overactive bladder score was statistically higher in patients with nocturia than in controls (9.14 ± 4.3 vs 5.1 ± 3.5, p = 8.21E-17). Mean maximum cystometric capacity was statistically greater in the control group than in patients with nocturia (380.17 ± 113.79 vs 313 ± 128.4 ml, p = 5.60E-6). A similar outcome was found for the first contraction (mean 232.58 ± 146.05 vs 181.14 ± 100.11 ml, p = 0.041). As isolated nocturia or nocturnal urinary incontinence is a frequent problem encountered with multiple sclerosis, this study bears an important message as it indicates that an overactive detrusor could be the main mechanism for nocturia in these patients. However nocturnal urine production and hence the eventual presence of nocturnal polyuria was not evaluated in these patients. As a consequence in an individual patient both elements have to be taken into account as this may have therapeutic consequences.