Aslı Aksoy GÜNDOĞDU, Hasan Salih SAĞLAM, Yavuz Tarık ATİK, Saadet SAYAN, Dilcan KOTAN

Lower Urinary Tract Dysfunction in Multiple Sclerosis Patients

Amaç Multipl Sklerozda (MS), alt üriner sistem fonksiyon bozuklukları oldukça sık görülmektedir. Çalışmamızda, MS hastalarında alt üriner sistem disfonksiyon semptomları ile hastalığın şiddeti, süresi, alt tipi ve lezyon lokalizasyonu arasındaki ilişkiyi göstermeyi amaçladık. Materyal ve Metod Son 3 ay içinde nöroloji polikliniğimize başvuran, MS tanılı 42 hastanın demografik özellikleri, MS alt tipi, hastalık süresi, hastalık şiddeti, nörolojik muayeneleri, genişletilmiş özürlülük durum ölçeği (EDSS) puanları, üriner sisteme ait yakınmaları, semptomların süreleri, üriner sistem muayeneleri, fonksiyon testleri (aşırı aktif mesane semptom skoru (OABSS), uluslararası prostat semptom skoru (IPSS)), ürodinamik değerlendirme sonuçları prospektif olarak kaydedildi. İstatistiksel analiz ANOVA, Mann-Whitney U ve non-parametrik Pearson testleri kullanılarak yapıldı. P0,05). İrritatif semptomlar ile cins ve EDSS arasında istatistiksel olarak anlamlı bir farklılık bulunurken (p0,05). İrritatif ve obstrüktif semptomların varlığı ile lezyon lokalizasyonu arasında da istatistiksel olarak anlamlı bir farklılık saptanmadı (p>0,05). Sonuç Çalışmamız MS' te hastalık şiddetinin irritatif üriner semptomlar üzerinde önemli bir belirleyici faktör olduğunu göstermektedir. ( Sakarya Tıp Dergisi 2016, 6(4):190-195 )

Multipl Skleroz Hastalarında Alt Üriner Sistem Disfonksiyonu

Objective Lower urinary tract dysfunction (LUTD) are quite commonly seen in Multiple Sclerosis (MS). In this study we aimed to show the relationship between the LUTD symptoms and disease related parameters including the severity, duration, subtypes and the lesion localization of MS. In a prospective study, we recorded demographic information, MS subtypes, disease duration, disease severity, neurological examinations, scores of Expanded Disability Status Scale (EDSS), lower urinary tract symptoms (LUTS), duration of the symptoms, urinary tract examination, urinary function tests (Overactive Bladder Symptom Score (OABSS), International Prostate Symptom Score (IPSS)), urodynamic evaluation results of 42 MS patients whom admitted to our neurology department during the last 3 months. Statistical analysis was performed by using ANOVA, Mann Whitney-U test and non-parametric Pearson test. p0,05). A statistically significant difference was found between the genders, EDSS and irritative symptoms (p0,05). There was no statistically significant difference between the localization of the lesion and presence of the irritative and obstructive symptoms (p>0,05). Conclusion Our study indicates that, disease severity is an important determinant factor of irritative urinary symptoms in MS patients. ( Sakarya Med J 2016, 6(4):190-195 )

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1. Global Initiative for Chronic Obstructive Lung Disease: Global strategy for diagnosis, management and prevention of Chronic Obstructive Pulmonary Disease updated 2006.
2. Mannino DM, Watt G, Hole D. The natural history of chronic obstructive pulmonary disease. Eur Respir J 2006; 27:627-43.
3. Alexander CM, Landsman PB, Teutsch SM, Haffner SM. NCEPdefined metabolic syndrome, diabetes and prevelance of coronary heart disease among NHANES III participants age 50 years and older. Diabetes 2003; 52:1210-1214.
4. Caso P, Galderisi M, Cicala S, Cioppa C, D'Andrea A, Lagioia G, et al. Association between myocardial right ventricular relaxation time and pulmonary arterial pressure in chronic obstructive lung disease: analysis by pulsed Doppler tissue imaging. J Am Soc Echocardiogr 2001;14:970-976.
5. Higham MA, Dawson D, Joshi J, Nihoyannopoulos P, Morrell NW. Utility of echocardiography in assessment of pulmonary hypertension secondary to COPD. Eur Respir J 2001;17:350- 355
6. Miyahara Y, Ikeda S, Yoshinaga T, amaguchi K, NishimuraShirono E, et al. Echocardiographic evaluation of right cardiac function in patients with chronic pulmonary diseases. Jpn Heart J 2001;42:483-493
7. Moustapha A, Kaushik V, Diaz S, Kang SH, Barasch E. Echocardiographic evaluation of left ventricular diastolic function in patients with chronic pulmonary hypertension. Cardiology 2001;95:96-100
8. Hinderliter AL, Willis PW 4th, Barst RJ, Rich S, Rubin LJ, Badesch DB, et al. Effects of long term infusion of prostacyclin (epoprostenol) on echocardiographic measures of right ventricular structure and function in primary pulmonary hypertension.Circulation 1997;95:1479
9. Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006 Nov 1;174:1034-41.
10. Nambi V, Chambless L, He M, He M, Hu Y, Mosley T, et al. Common carotid artery intima-media thickness is a good as carotid intima-media thickness of all carotid artery segments in improving prediction of coronary heart disease risk in the Atherosclerosis Risk in Communities (ARIC) study. Eur Heart J 2012 Jan;33:183-90.
11. Lorenz MW, Schaefer C, Steinmetz H, Sitzer M. Is carotid intima media thickness useful for individual prediction of cardiovascular risk? Ten-year results from the Carotid Atherosclerosis Progression Study (CAPS). Eur Heart J 2010 Aug;31:2041-8.
12. Cao JJ, Arnold AM, Manolio TA, Polak JF, Psaty BM, Hirsch CH, et al. Association of carotid artery intima-media thickness, plaques, and C-reactive Protein with future cardiovascular disease and all-cause mortality: The Cardiovascular Health Study. Circulation 2007 Jul 3;116:32-8.
13. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: A systematic review and meta-analysis. Circulation 2007 Jan 30;115:459-67.
14. Van Gestel YR, Flu WJ, van Kuijk JP, Hoeks SE, Bax JJ, Sin DD, et al. Association of COPD with carotid wall intima-media thickness in vascular surgery patients. Respir Med. 2010 May;104:712-6.
15. Köseoğlu C, Kurmus O, Ertem AG, Colak B, Kırbas O, Bilen E, et al. FEV1 can predict SYNTAX score in patients with chronic obtructive pulmonary disease. Kardiol Pol. 2015 Dec 1. doi: 10.5603/KP.a2015.0236.
16. Schroeder EB, Welch VL, Evans GW, Heiss G. Impaired lung function and subclinical atherosclerosis. The ARIC Study. Atherosclerosis 2005 Jun;180:367-373.
17. Barr RG, Ahmed FS, Carr JJ, Hoffman EA, Jiang R, Kawut SM, et al. Subclinical atherosclerosis, airflow obstruction and emphysema: the MESA Lung Study. Eur Respir J 2012 Apr;39:846-54.
18. American Thoracic Society.Standardization of spirometry, 1994 update. Ameri J Respir Crit Care Med 1995;152:1107-36.
19. Report of the American Society of Echocardiography Commitee on nomenclature and standarts in two dimensional echocardiography. Circulation 1980;62:212-7
20. Ueti OM, Camargo EE, Ueti Ade A, de Lima-Filho EC, Nogueira EA. Assessment of right ventricular function with Doppler echocardiographic in¬dices derived from tricuspid annular motion: comparison with radionuclide angiography. Heart 2002;88:244-8
21. Currie PJ, Seward JB, Chan KL, Fyfa DA, Hagler DJ, Mair DD, et al. Continuos wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol 1985;6:750-6
22. Epping-Jordan JE, Galea G, Tukuitonga C, Beaglehole R. Preventing chronic diseases: taking stepwise action. Lancet 2005; 366:1667-1671.
23. Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J 2006; 28:1245-1257. 24. Trends in Pharmacological sciences volume 28, october 2007; 10: 544-550.
25. Kenji Minoguchi, Takuya Yokoe, Toshiyuki Tazaki. Increased Carotid Intima-Media Thickness and Serum İnflammatory Markers in Obstructive Sleep Apnea. Am J Respir Crit Care Med 2005:625-630.
26. Eickhoff P, Valipour A, Kiss D, Schreder M, Cekici L, Geyer K, et al. Determinants of systemic vascular function in patients with stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008; 178: 1211-8.
27. Kim SJ, Yoon DW, Lee EJ, Hur GY, Jung KH, Lee SY, et al. Carotid atherosclerosis in patients with untreated chronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2011; 15: 1265-70.
28. Tarhan F, Kuyumcuoğlu U, Yücetaş U, İlhan S, Türk Börü Ü, Erdoğan H. Multipl Sklerozlu Hastalarda Uluslararası Prostat Semptom Skoru Ve Aşırı Aktif Mesane Sorgulaması İle Hastalıkla İlgili Ölçütler Ve Yaşam Kalitesi Arasındaki İlişki Türk Üroloji Dergisi: 33 (2): 218-222, 2007
29. Di Benedetto P, Delneri C, Biasutti E, Bragadin LM, Giorgini T. Vesicourethral dysfunction in multiple sclerosis. Initial assessment based on lower urinary tract symptoms and their pathophysiology. Neurological Sciences 2008;29(Suppl. 4):S348–51.
30. Ebers GC, Sadovnick AD, Risch NJ. A genetic basis for familial aggregation in multiple sclerosis. Canadian Collaborative Study Group. Nature 1995;377:150-1.
31. Poser CM. The epidemiology of multiple sclerosis: a general overview. Anne Neurol 1994;36:S180-93.
32. Nortvedt MW, Riise T, Frugård J, Mohn J, Bakke A, Skår AB, Nyland H, Glad SB, Myhr KM: Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis. Mult Scler. 2007, 13:106-12.
33. Kim YH, Goodman C, Omessi E, Rivera V, Kattan MW, Boone TB: The correlation of urodynamic findings with cranial magnetic resonance imaging findings in multiple sclerosis. J Urol. 1998, 159:972-6.
34. Hinson JL, Boone TB: Urodynamics and multiple sclerosis. Urol Clin North Amer. 1996, 23: 475-481