Lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis

André Luiz Farinhas Tomé,Eduardo P Miranda,José De Bessa Júnior,Carlos Alberto Bezerra,Antônio Carlos Lima Pompeo,Sidney Glina,Cristiano Mendes Gomes

doi:10.6061/clinics/2019/e713

Abstract

OBJECTIVES:To assess the prevalence and interrelationship between lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis (MS).METHODS:In a cross-sectional study, we evaluated 41 men (mean age 41.1±9.9 years) with MS from February 2011 to March 2013, who were invited to participate irrespective of the presence of lower urinary tract symptoms or sexual dysfunction. Neurological impairment was assessed with the Expanded Disability Status Scale; lower urinary tract symptoms were evaluated with the International Continence Society male short-form questionnaire, and sexual dysfunction was evaluated with the International Index of Erectile Function. All patients underwent transabdominal urinary tract sonography and urine culture.RESULTS:The mean disease duration was 10.5±7.3 years. Neurological evaluation showed a median Expanded Disability Status Scale score of 3 [2-6]. The median International Continence Society male short-form questionnaire score was 17 [10-25]. The median International Index of Erectile Function score was 29 [15-46]. Twenty-nine patients (74.4%) had sexual dysfunction as defined by an International Index of Erectile Function score <45. Voiding dysfunction and sexual dysfunction increased with the degree of neurological impairment (r=0.02 [0.02 to 0.36] p=0.03 and r=-0.41 [-0.65 to -0.11] p=0.008, respectively). Lower urinary tract symptoms and sexual dysfunction also displayed a significant correlation (r=-0.31 [-0.56 to -0.01] p=0.04).CONCLUSIONS:Most male patients with MS have lower urinary tract symptoms and sexual dysfunction. The severity of the neurological disease is a predictive factor for the occurrence of voiding and sexual dysfunctions.

Highlights

Multiple sclerosis (MS) is the most common neurological disease in young adults, with peak incidence between ages 30 and 35 [1]
Neurological Assessment The severity of neurological impairment was assessed with the Expanded Disability Status Scale (EDSS, ranging from 0 to 10), which was performed by neurologists who specialized in demyelinating diseases
A correlation was observed between the severity of Lower urinary tract symptoms (LUTS) and the presence of Sexual dysfunction (SD) (r=-0.31 [-0.56 to -0.01]; p=0.04), demonstrating that more severe LUTS are associated with worse sexual function. In this cross-sectional study, we evaluated a population of men with MS to determine the prevalence and characteristics of LUTS and SD and their relationship to neurological impairment

Summary

Introduction

Multiple sclerosis (MS) is the most common neurological disease in young adults, with peak incidence between ages 30 and 35 [1]. It is a chronic and progressive immunemediated inflammatory disease that affects the central nervous system. MS may manifest different neurological symptoms and usually progresses to loss of physical and cognitive capabilities [2,3]. Lower urinary tract symptoms (LUTS) are frequent in MS patients [4]. After 10 years of disease activity, it is estimated that more than 90% of MS patients report LUTS, and 70-80% have changes in voiding patterns during follow-up [4].

Objectives

Methods

Results

Discussion

Conclusion