Neurogenic Lower Urinary Tract Dysfunction in Asymptomatic Patients with Multiple Sclerosis.

Neurogenic lower urinary tract dysfunction (NLUTD) in asymptomatic patients with MS has been described in preliminary studies, but specific investigations of this topic are rare. Many authors advise early diagnosis and treatment of NLUTD in patients with MS. In contrast, clinical practice and different guidelines recommend neuro-urological diagnostics only in the presence of symptoms. Our aim was to investigate the characteristics of NLUTD and the correlations of clinical parameters with NLUTD in asymptomatic patients with MS. We evaluated bladder diaries, urodynamic findings, and therapy proposals. Correlations of the voided volume, voiding frequency, urinary tract infections, and uroflowmetry including post-void residual with the urodynamic findings were determined. In our study, 26% of the patients were asymptomatic. Of these, 73.7% had urodynamic findings indicative of NLUTD, 21.1% had detrusor overactivity, 13.2% had detrusor underactivity, 13.2% detrusor overactivity and detrusor sphincter dyssynergia, and 57.9% had radiologically abnormal findings of the bladder. No patients presented low bladder compliance or renal reflux. Clinical parameters from the bladder diary and urinary tract infections were found to be correlated with NLUTD, and the absence of symptoms did not exclude NLUTD in patients with MS. We observed that urinary tract damage is already present in a relevant proportion. Based on our results, we recommend that patients with MS be screened for NLUTD regardless of the subjective presence of urinary symptoms or the disease stage.

Non-invasive assessment of urinary bladder compliance using ultrasound: first validation study based on clinical urodynamic study.

BACKGROUND: This study aims to validate a recently introduced non-invasive method, ultrasound bladder vibrometry (UBV), for the assessment of detrusor compliance in patients with neurogenic bladders. METHODS: The study was carried out on 79 adult patients with neurogenic bladders (60 male and 19 female). The UBV test was performed on each patient to measure the Lamb wave group velocity (cg ) in the anterior bladder wall at every 50mL volume increment throughout the filling phase. Bladder compliance was assessed based on the trend of Lamb wave group velocity squared (cg 2 ) versus volume. A compliance index was defined to differentiate between the compliant and non-compliant bladders. Results of the UBV compliance assessment were validated using the readings of the corresponding urodynamic studies as the clinical gold standard. RESULTS: The Patients' bladders were divided into non-compliant and compliant groups by an experienced urologist using the information in the urodynamic study (UDS) recordings. The compliance index defined on the basis of cg 2 showed a significant difference (P<0.008) between the compliant and non-compliant groups. The areas under the receiver operating characteristic curve were 0.813, with 95% CI ranging from 0.709 to 0.892. Under the optimal criterion, the bladder was considered as non-compliant if the compliance index was less than 100 mL∙s2/m2, resulting in a sensitivity and specificity of 86.4% and 71.9%, respectively. CONCLUSIONS: The results of this study demonstrate that UBV can be used as a non-invasive method for the determination of bladder compliance; thus, it can potentially serve as an alternative method to UDS for the appropriate patient groups.

Melanosis of the bladder: A rare diagnosis.

Melanosis of the bladder is characterized by dark, velvety bladder mucosa due to melanin deposition. Less than 25 cases have been reported. We present a 45-year-old male undergoing work up for obstructive and storage irritative lower urinary tract symptoms, found to have diffuse bladder melanosis on cystoscopy with bladder biopsy, and detrusor overactivity on urodynamic study. Although bladder melanosis has been found before in conjunction with storage voiding symptoms, this is the first report to our knowledge of an association with overactive bladder with urodynamic and histologic confirmation.

Study of correlation of urodynamic profile with symptom scoring and ultrasonographic parameters in patients with benign prostatic hyperplasia.

CONTEXT: Urodynamic study (UDS) and ultrasonography (USG) both are established investigations to assess the patients of benign prostatic hyperplasia (BPH). It is known that the prostate mass (PM) and post-void residual urine volume (PVR) are not significantly related to the patients' symptoms and degree of obstruction; however, the relation between the UDS, USG and patient's International Prostate Symptom Scoring (IPSS) has not been defined. AIMS: To correlate the urodynamic parameters with IPSS, PM and PVR in patients with lower urinary tract symptoms (LUTS) suggestive of BPH. SETTINGS AND DESIGN: An observational study carried out as a thesis project. METHODS AND MATERIALS: Thirty male patients aged more than 40 years with LUTS suggestive of BPH were selected and underwent USG, UDS and IPSS. In UDS, the parameters studied were the maximum flow rate (Qmax), detrusor pressure (Pdet) and bladder compliance (BC). PM and PVR were studied in the USG. STATISTICAL ANALYSIS USED: IBM Statistical Package for the Social Sciences (SPSS) software version 16 (SPSS Inc., Chicago, USA). Pearson's correlation and two-sided significance levels were determined. RESULTS: 1. Significant negative correlation between Qmax and PVRUSG (r = -0.404, P = 0.027); PMUSG (r = -0.655, P = <0.001) and IPSS (r = -0.563, P = 0.001). 2. Significant positive correlation between Pdet and PVRUSG (r = 0.535, P = 0.002); PMUSG (r = 0.719, P = <0.001) and IPSS (r = 0.649, P = <0.001). 3. Significant negative correlation between BC and PVRUSG (r = -0.490, P = 0.006); PMUSG (r = -0.654, P = <0.001) and IPSS (r = -0.667, P = <0.001). CONCLUSIONS: UDS has a significant correlation with IPSS and USG findings and urodynamic parameters give a more specific diagnosis in BPH patients when it is combined with USG and IPSS.