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kontinenz aktuell - Ausgabe 01-2012

kontinenz aktuell März/2012 15 Titelthema Einleitung Multiple Sklerose ist eine vermutlich durch Autoimmunprozesse verur- sachte neurodegenerative Erkran- kung von Rückenmark und Gehirn, deren Ursachen bisher nicht geklärt sind. Ätiologisch werden Umwelteinflüsse (1;2), genetische Faktoren (3-5), kindliche (virale) Infektionen (6), Vitamin-D-Mangel (7;8), Rauchen (9), cerebrovenöse Insuffizienz (10) und Stress (11) diskutiert. Frauen sind 3 – 4 x häu- figer betroffen (12). Die Symp- tomatik tritt meist im jüngeren Erwachsenenalter erstmals auf und kann je nach Lokalisation der Ent- markungsherde im ZNS variabel sein. Paresen, Parästhesien, Spas- men, aber auch Ataxien, Schluck- störungen, Sehstörungen und eine erhöhte Ermüdbarkeit können auf- treten. Schubförmige und chroni- sche Verlaufstypen sind möglich (13;14). Lower urinary tract symp- toms (LUTS) bestehen neben oph- thalmologischen und neurologi- schen Erscheinungen bei 75 % der Betroffenen (15;16). Die W ahr- scheinlichkeit einer Har ninkonti- nenz ist bei MS-Patienten um den Faktor 21,9 erhöht (17). Es beste- hen nicht nur gravierende Auswir- Can clinical data predict pathological urodynamics in MS? A prospective analysis of 100 cases Summary Background: Urinary tract complaints are an underestimated problem in multiple sclerosis (MS). It is unclear at which point in the disease they can occur, whether they are associated with the degree of disability, and whether there is a correlation with a certain form of MS. Patients and methods: All MS patients undergoing rehabilitation in an in-patient facility who had urinary tract problems were given a urine test and a urination log and a residual urine ultrasound and urodynamic testing performed accor- ding to the ICS standard. Results: Between 10/2009 and 3/2011, 100 patients (79 women, 21 men, mean age: 49.4 ± 10.9 years, mean EDSS 4.52 ± 2.26) with primary progressive MS (9 x), acute MS (41 x), secondary progressive MS (43 x) and CIS (1 x) were examined. The mean duration of the MS was 10.26 ± 10.09 years, that of the lower urinary tract symptoms 6.9 ± 7.75 years. The urodynamic testing showed 22 normal subjects, 7 overactive bladders (OAB) with unstable detrusor contractions, 21 OABs without unstable detrusor contractions, 26 cases of detrusor-sphincter dyssynergia, 12 cases of detrusor hypocontractility, 4 cases of detrusor acontractility and unclear urodynamic findings in 8 patients. Patients with an OAB with uninhibited detrusor contractions had a degree of disability comparable to a patient with normal findings. Statistically significant risk factors for pathological urodynamics were wheelchair dependency, use of more than one pattern/day, and a non-acute type of MS. Conclusions: The urodynamic testing being discussed here revealed what was in some cases severe bladder dysfunction in 78 of 100 MS patients with LUTS. The long latency period between the occurrence of the MS or the beginning of LUTS and the first neuro-urological evaluation suggests inadequate care. According to existing guidelines, all MS patients should be asked regularly about LUTS and undergo urodynamic testing, particularly in cases of the described risk profile. Key words: Neuro-urology, multiple sclerosis, urinary tract problems, urodynamics Foto:Fotolia