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Re: Renal Deterioration in Multiple Sclerosis Patients with Neurovesical Dysfunction
2034
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
this issue is important in evaluating teenagers and young adults with severe lower urinary tract symptoms whose etiology is obscure. Alan J. Wein, MD, PhD (hon)
Re: Renal Deterioration in Multiple Sclerosis Patients with Neurovesical Dysfunction S. G. Fletcher, B. E. Dillon, A. S. Gilchrist, R. M. Haverkorn, J. Yan, E. M. Frohman and G. E. Lemack Department of Urology, Methodist Hospital, Houston, Texas Mult Scler 2013; 19: 1169e1174.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.058 available at http://jurology.com/ Editorial Comment: This article reconfirms and restates findings previously reported by Lemack et al with respect to upper tract deterioration in patients with multiple sclerosis and detrusor sphincter dyssynergia as compared to those with spinal cord injury.1 Quoting from the article, multiple sclerosis affects 85 of 100,000 people in the United States and urinary symptoms are reported in up to 90%, with urodynamic abnormalities being reported in 99% of symptomatic patients. The findings of detrusor overactivity, detrusor sphincter dyssynergia and “detrusor hypocontractility” have been cited as being 99%, 83% and 40% in these patients, respectively. The literature cites upper urinary tract abnormalities in multiple sclerosis as being reported in 0% to 25% of patients. In this series with a median followup to 61 months abnormalities on initial renal ultrasound were found in 5.8% of patients and at followup in 12.4%. Patients older than 49 years were more likely to have an abnormality (OR 0.181), as were those with abnormal compliance (OR 0.185). Patients with radiological abnormalities had abnormal creatinine levels. The overall conclusion is that the “clinically stable [multiple sclerosis] patient is at a low risk for having upper urinary tract pathology.” Alan J. Wein, MD, PhD (hon) 1. Lemack GE, Hawker K and Frohman E: Incidence of upper tract abnormalities in patients with neurovesical dysfunction secondary to multiple sclerosis: analysis of risk factors at initial urologic evaluation. Urology 2005; 65: 854.
Suggested Reading Sirls LT, Zimmern PE and Leach GE: Role of limited evaluation and aggressive medical management in multiple sclerosis: a review of 113 patients. J Urol 1994; 151: 946. Koldewijn EL, Hommes OR, Lemmens WA et al: Relationship between lower urinary tract abnormalities and disease-related parameters in multiple sclerosis. J Urol 1995; 154: 169.
Re: Urinary Retention: Benefit of Gradual Bladder DecompressiondMyth or Truth? A Randomized Controlled Trial S. Boettcher, A. S. Brandt, S. Roth, M. J. Mathers and D. A. Lazica Department of Urology, HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany Urol Int 2013; 91: 140e144.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.059 available at http://jurology.com/ Editorial Comment: Occasionally we are asked for literature backup for something that we as urologists know to be true but is disputed by individuals from other, generally nonsurgical services.
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
this issue is important in evaluating teenagers and young adults with severe lower urinary tract symptoms whose etiology is obscure. Alan J. Wein, MD, PhD (hon)
Re: Renal Deterioration in Multiple Sclerosis Patients with Neurovesical Dysfunction S. G. Fletcher, B. E. Dillon, A. S. Gilchrist, R. M. Haverkorn, J. Yan, E. M. Frohman and G. E. Lemack Department of Urology, Methodist Hospital, Houston, Texas Mult Scler 2013; 19: 1169e1174.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.058 available at http://jurology.com/ Editorial Comment: This article reconfirms and restates findings previously reported by Lemack et al with respect to upper tract deterioration in patients with multiple sclerosis and detrusor sphincter dyssynergia as compared to those with spinal cord injury.1 Quoting from the article, multiple sclerosis affects 85 of 100,000 people in the United States and urinary symptoms are reported in up to 90%, with urodynamic abnormalities being reported in 99% of symptomatic patients. The findings of detrusor overactivity, detrusor sphincter dyssynergia and “detrusor hypocontractility” have been cited as being 99%, 83% and 40% in these patients, respectively. The literature cites upper urinary tract abnormalities in multiple sclerosis as being reported in 0% to 25% of patients. In this series with a median followup to 61 months abnormalities on initial renal ultrasound were found in 5.8% of patients and at followup in 12.4%. Patients older than 49 years were more likely to have an abnormality (OR 0.181), as were those with abnormal compliance (OR 0.185). Patients with radiological abnormalities had abnormal creatinine levels. The overall conclusion is that the “clinically stable [multiple sclerosis] patient is at a low risk for having upper urinary tract pathology.” Alan J. Wein, MD, PhD (hon) 1. Lemack GE, Hawker K and Frohman E: Incidence of upper tract abnormalities in patients with neurovesical dysfunction secondary to multiple sclerosis: analysis of risk factors at initial urologic evaluation. Urology 2005; 65: 854.
Suggested Reading Sirls LT, Zimmern PE and Leach GE: Role of limited evaluation and aggressive medical management in multiple sclerosis: a review of 113 patients. J Urol 1994; 151: 946. Koldewijn EL, Hommes OR, Lemmens WA et al: Relationship between lower urinary tract abnormalities and disease-related parameters in multiple sclerosis. J Urol 1995; 154: 169.
Re: Urinary Retention: Benefit of Gradual Bladder DecompressiondMyth or Truth? A Randomized Controlled Trial S. Boettcher, A. S. Brandt, S. Roth, M. J. Mathers and D. A. Lazica Department of Urology, HELIOS Klinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany Urol Int 2013; 91: 140e144.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.059 available at http://jurology.com/ Editorial Comment: Occasionally we are asked for literature backup for something that we as urologists know to be true but is disputed by individuals from other, generally nonsurgical services.