Эпидемиология и характер расстройств мочеиспускания у больных рассеянным склерозом

Introduction . Data on the epidemiology and nature of neurogenic lower urinary tract dysfunction (NLUTD) in multiple sclerosis (MS) are contradictory: the prevalence rate ranges from 50 to 90% according to different authors. Purpose of the study . To assess the frequency and nature of urination disorders in patients with various forms of multiple sclerosis. Materials and methods . We analyzed the data of patients observed in the Regional Centre of Multiple sclerosis at Sverdlovsk Regional Clinical Hospital No. 1. The study included 160 patients aged 42.6±12.3 years, of which 64% were men and 36% were women. The primary progressive course of the disease occurred in 5% of patients, the secondary progressive course in 39%, and remitting in 56%. The average score according to the Expanded Disability Status Scale (EDSS) was 3.94±2.10. The nature of neurogenic dysfunction of the lower urinary tract was evaluated using questionnaires (NBSS, SF-Qualiveen) and urodynamic studies. Results . NLUTD were detected in 65% of MS patients. The average score according to the Neurogenic Bladder Symptom Scale (NBSS) in patients with NLUTD was 26.93±13.12, which was significantly (p < 0.001) exceed than the value of this indicator among patients without pelvic disorders (6.43±2.34). Symptoms of emptying were noted in more than half of patients with a neurogenic bladder in the presence of multiple sclerosis: poor urine flow (63%), abdominal straining during urination (76%). Complaints of storage symptoms, such as urgency and frequency, were presented by 98% of patients with neurogenic lower urinary tract dysfunction. Urinary incontinence was diagnosed in 84% of cases. The values of the «incontinence», «storage and voiding» and «complications» domains of NBSS were 8.66±7.17, 12.18±3.7 and 3.48±4.21, respectively. The total score of SF-Qaliveen questionnaire in patients with MS with urinary disorders was 2.93±1.13, in patients without NLUTD, 1.03±0.91 (р < 0,001). Conclusions. Neurogenic lower urinary tract dysfunction occurs in patients with multiple sclerosis with a frequency of 65%. These urinary disorders have a significant impact on the patients` quality of life.