Utilization of third line therapy in the urologic management of patients with multiple sclerosis

Introduction: Multiple sclerosis (MS) is a demyelinating neurologic condition affecting approximately 2 million people worldwide. Lower urinary tract symptoms (LUTS) affect up to 50%‐90% of MS patients. Urodynamic (UD) evaluation for these patients often shows evidence of Neurogenic Detrusor Overactivity (NDO). Treatment strategies include behavioral and physical therapy, oral medications, and third line therapies (intravesical botox, Interstim, PTNS). We sought to characterize MS patients with NDO, measure changes in urinary quality of life with treatment, and evaluate for any factors predictive of progression to third line therapies. Methods: Using a prospectively collected, routinely updated database of MS patients within a single neuro‐urologist practice between 2013‐2019, patient demographics, UD data, treatment variables, and pre‐ and posttreatment patient‐reported questionnaire responses were recorded. We present descriptive characteristics of the patients with NDO within this cohort. We grouped these patients into two groups: those who progress to third line therapy and those who remain on medical therapy. We evaluate for any differences in UD characteristics between these groups and compare the degree of change in symptom and quality of life scores. Urodynamic and quality of life data were compared using chi‐square and Wilcoxon rank sum statistics, respectively. Results: Our cohort of 182 patients with MS, averages 55 years of age, is 84% female and 45% Caucasian. Nearly 50% of these patients are diagnosed with relapsing remitting MS. Eighty percent of our patients underwent UD, with findings showing detrusor sphincter dyssynergia (DSD) in 24% and NDO in 45% (66 patients). Nearly 40% of patients with NDO progress to third line therapy with intravesical botox being the most common in our cohort (89%). As seen in the Table, there were no demographic or UD factors predictive of progressing to third line therapy. However, patients who undergo third line therapy show larger improvements in symptom score than those who do not. Conclusion: NDO is a common cause for LUTS in patients with MS. 40% of our MS patients with NDO progress to third line therapy with no UD factors predictive of progression. Symptom improvements are greater those patients who undergo third line therapies compared to those who remain on medical therapy