Urologic Care of a Multiple Sclerosis Patient Population-Single Provider Experience

Introduction: Multiple sclerosis (MS) is a demylinating neurologic condition affecting approximately 2 million people worldwide. Lower urinary tract dysfunction is common with 50-90% having voiding symptoms. If lower urinary tract symptoms are recognized and a urological referral is made, little is known regarding the outcomes of these patients within a urology practice. The objective of this study was to evaluate the MS population of a single provider to gain a better understanding of patient characteristics, urodynamic findings, treatment outcomes and follow-up patterns. Methods: A retrospective chart review was performed on all patients with a diagnosis of multiple sclerosis in the practice of a single provider at Vattikuti Urology Institute from January 2013 to December 2017. Patient demographics, urodynamic study (UDS) data, management outcomes and patient reported questionnaire responses were recorded and analyzed with descriptive statistics. Results: A total of 147 patients were initially included with a diagnosis of MS. Please see Table 1 for patient characteristics. After removing patients lost to follow-up, 47.6% of the original population was considered active. Among those that did undergo UDS (120), 24% had a diagnosis of detrusor sphincter dyssynergia, 60% had neurogenic detrusor overactivity (NDO) and 33% had poor detrusor function. Some element of the overactive bladder symptom complex was the presenting chief complaint of 107/147 patients. Among the active patients with NDO, 48.7% received botox. For the active NDO patients that did receive botox, statistical significance was found in the change of all urinary quality of life (QOL) questionnaires (AUA-SS, AUA QOL, Michigan Incontinence Symptom Index) that were used between pre and post treatment. There was no statistically significant change in QOL scores for the active NDO population that had not received botox. Conclusion: Significant barriers exist for patients with MS. Given the improvement in quality of life that can be achieved with appropriate treatment and the significant number of patients that are lost to follow-up, it is important to provide patients with education regarding the effects of MS on their urinary system at their initial visit. A treatment pathway, patient navigator and multidisciplinary approach could be helpful to improve patient outcomes