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Stritt K, Lucca I, Roth B, Grilo N. Is EDSS Enough to Predict Risk of Upper Urinary Tract Damage in Patients with Multiple Sclerosis? Biomedicines 2022; 10:biomedicines10123001. [PMID: 36551757 PMCID: PMC9775948 DOI: 10.3390/biomedicines10123001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Lower urinary tract dysfunction is often observed in patients with multiple sclerosis (MS) and may be responsible for an increased risk of upper urinary tract (UUT) damage. Although there are well-known urodynamic risk factors for UUT damage, no clinical prediction parameters are clearly identified. We aimed to confirm the accuracy of the Expanded Disability Status Scale (EDSS) in predicting urodynamic risk factors for UUT deterioration and to assess other clinical parameters potentially predicting urodynamic risk factors. We retrospectively reviewed 201 patients with MS referred for primary neuro-urological work-up, including a video-urodynamic study (VUDS) from August 2009 to February 2020. Multivariate modeling revealed EDSS, male gender, and a number of LUTS as clinical parameters significantly associated with urodynamic risk factors for UUT damage (p = 0.06, p = 0.01, p = 0.02, respectively). A nomogram combining EDSS, male gender, and a number of different LUTS was created to predict the presence of at least one urodynamic risk factor for UUT damage. In conclusion, the presence of high EDSS combined with male gender and several different LUTS is significantly associated with urodynamic risk factors and can be used to stratify MS patients for further neuro-urological assessment and treatment.
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Piquet V, Turmel N, Chesnel C, Haddad R, Lebreton F, Amarenco G, Hentzen C. Upper urinary tract function of patients with multiple sclerosis. Neurourol Urodyn 2021; 41:498-505. [PMID: 34931344 DOI: 10.1002/nau.24860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/04/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neurogenic lower urinary tract dysfunction (NLUTD) is frequent in multiple sclerosis (MS) and renal prognosis is a key point of bladder management. OBJECTIVE To assess upper urinary tract damage risk using voiding cystourethrography (VCUG) in patients with (PwMS) and NLUTD. METHODS We conducted a retrospective study between 2010 and 2020. Demographic data, urinary symptoms, urinary tract infection (UTI), renal ultrasounds findings, glomerular filtration rate (GFR), VCUG data, and urodynamic parameters were collected in PwMS with NLUTD. RESULTS Among 325 PwMS included, 67% were female, mean age was 51.6 ± 12.0 years, and mean EDSS 4.6 ± 1.8. VCUG showed vesicoureteral reflux (VUR) in 18 patients. A link was found between VUR and progressive MS course (p = 0.04), hydronephrosis (odds ratio [OR] = 17.44; 95% confidence interval [CI] = 3.46-87.87; p = 0.001), low GFR (p < 0.001), and detrusor overactivity (p = 0.04). No association with UTIs, EDSS, detrusor sphincter dyssynergia, were elicited. On multivariate analysis, alteration of GFR was independently related to the presence of VUR (OR = 0.95; 95% CI = 0.92-0.98). CONCLUSIONS VUR elicited on VCUG is associated with lower GFR and hydronephrosis. However, due to the low prevalence (5.5%) of this abnormality in PwMS, VCUG should be performed in selected cases and not in routinary practice.
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Affiliation(s)
- Violaine Piquet
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Nicolas Turmel
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France.,Service de Médecine physique et de réadaptation, Hôpital Danielle Casanova, Saint-Denis, France
| | - Camille Chesnel
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Rebecca Haddad
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Frédérique Lebreton
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Gérard Amarenco
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Claire Hentzen
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
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Candida tropicalis Systemic Infection Redirects Leukocyte Infiltration to the Kidneys Attenuating Encephalomyelitis. J Fungi (Basel) 2021; 7:jof7090757. [PMID: 34575795 PMCID: PMC8471291 DOI: 10.3390/jof7090757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/04/2021] [Accepted: 09/10/2021] [Indexed: 01/08/2023] Open
Abstract
Environmental factors, including infections, are strongly associated with the pathogenesis of multiple sclerosis (MS), which is an autoimmune and demyelinating disease of the central nervous system (CNS). Although classically associated with bacterial and viral agents, fungal species have also been suspected to affect the course of the disease. Candida tropicalis is an opportunistic fungus that affects immunocompromised individuals and is also able to spread to vital organs. As C. tropicalis has been increasingly isolated from systemic infections, we aimed to evaluate the effect of this fungus on experimental autoimmune encephalomyelitis (EAE), a murine model to study MS. For this, EAE was induced in female C57BL/6 mice 3 days after infection with 106 viable C. tropicalis yeasts. The infection decreased EAE prevalence and severity, confirmed by the less inflammatory infiltrate and less demyelization in the lumbar spinal cord. Despite this, C. tropicalis infection associated with EAE results in the death of some animals and increased urea and creatinine serum levels. The kidneys of EAE-infected mice showed higher fungal load associated with increased leukocyte infiltration (CD45+ cells) and higher expression of T-box transcription factor (Tbx21) and forkhead box P3 (Foxp3). Altogether, our results demonstrate that although C. tropicalis infection reduces the prevalence and severity of EAE, partially due to the sequestration of leukocytes by the inflamed renal tissue, this effect is associated with a poor disease outcome.
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Títoff IB, Titoff V, Scott TF. Is baseline routine renal ultrasound indicated for all MS patients? Postgrad Med J 2019; 96:194-196. [PMID: 31611266 DOI: 10.1136/postgradmedj-2019-136838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/19/2019] [Accepted: 09/30/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Most patients with multiple sclerosis (MS) develop multiple urological complaints due to hyperactive or hypoactive bladder, and may have detrusor-sphincter dyssynergia. Routine renal ultrasound (RUS) screening has been recommended for both symptomatic and asymptomatic MS patients; however, there is little data to support this practice. METHODS Prospectively screened consecutive MS clinic patients in 2016-2017 with functional systems scores (FSS) indicating moderate to severe neurogenic bladder symptoms (FSS bladder ≥2) were sent for RUS. We also screened for history of urinary tract infections. RESULTS 872 patients were screened between 3 September 2016 and 13 April 2017. 58 patients met inclusion criteria for RUS. 6 were excluded due to non-compliance with testing or unavailability of results; 52 patients were imaged. Only 3/52 patients were found to have renal pathology requiring follow-up. Of those three, one had known symptomatic nephrolithiasis, and one had subsequently normal findings, leaving one patient newly found to have valid abnormal upper urinary tract (UUT) findings. Multiple incidental findings were also discovered. CONCLUSION The minimal yield for significant UUT pathology found in this enriched group of symptomatic MS patients indicates that RUS screening for asymptomatic MS patients without clear risk factors is not indicated. Red flags for high risk of UUT complications should be used as triggers for baseline RUS screening in MS patients.
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Affiliation(s)
- Igor B Títoff
- Neurology and Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Victoria Titoff
- Neurology and Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Thomas F Scott
- Neurology and Neuroscience Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Musco S, Padilla-Fernández B, Del Popolo G, Bonifazi M, Blok BFM, Groen J, 't Hoen L, Pannek J, Bonzon J, Kessler TM, Schneider MP, Gross T, Karsenty G, Phé V, Hamid R, Ecclestone H, Castro-Diaz D. Value of urodynamic findings in predicting upper urinary tract damage in neuro-urological patients: A systematic review. Neurourol Urodyn 2018; 37:1522-1540. [PMID: 29392753 DOI: 10.1002/nau.23501] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/01/2017] [Indexed: 11/07/2022]
Abstract
AIM The main goals of neurogenic lower urinary tract dysfunction (NLUTD) management are preventing upper urinary tract damage (UUTD), improving continence, and quality of life. Here, we aimed to systematically assess all available evidence on urodynamics predicting UUTD in patients with NLUTD. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was performed in March 2017. Only neuro-urological patients assessed by urodynamics were included. Any outcome of upper urinary tract function were evaluated. RESULTS Forty-nine studies (1 randomized controlled trial, 9 prospective, and 39 retrospective case series) reported urodynamic data on 4930 neuro-urological patients. Of those, 2828 (98%) were spina bifida (SB) children. The total number of adults was 2044, mainly having spinal cord injury (SCI) (60%). A low bladder compliance was found in 568 (46.3%) and 341 (29.3%) of the paediatric and adult population, respectively. Hydronephrosis (HDN) was detected in 557 children (27.8%) in 19/28 studies and 178 adults (14.6%), mainly SCI, in 14/21 studies. Nine out of 30 multiple sclerosis (MS) patients affected by HDN (16.8%) showed low compliance in 4/14 studies. CONCLUSIONS Patients with SB and SCI have a higher risk of developing UUTD (mainly reported as HDN) compared to those with MS. Reduced compliance and high DLPP were major risk factors for UUTD. Although our findings clarify the mandatory role of urodynamics in the management of NLUTD, standardization and better implementation of assessments in daily practice may further improve outcomes of neuro-urological patients based on objective measurements, that is, urodynamics.
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Affiliation(s)
- Stefania Musco
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Barbara Padilla-Fernández
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Giulio Del Popolo
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Matteo Bonifazi
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lisette 't Hoen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Jerome Bonzon
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Marc P Schneider
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Tobias Gross
- Department of Urology, University of Bern, Inselspital, Bern, Switzerland
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Paris 6 University, Paris Cedex 13, France
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Hazel Ecclestone
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - David Castro-Diaz
- Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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Ineichen BV, Schneider MP, Hlavica M, Hagenbuch N, Linnebank M, Kessler TM. High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis. Mult Scler 2017; 24:529-534. [PMID: 28367674 DOI: 10.1177/1352458517703801] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurogenic lower urinary tract dysfunction (NLUTD) is very common in patients with multiple sclerosis (MS), and it might jeopardize renal function and thereby increase mortality. Although there are well-known urodynamic risk factors for upper urinary tract damage, no clinical prediction parameters are available. OBJECTIVE We aimed to assess clinical parameters potentially predicting urodynamic risk factors for upper urinary tract damage. METHODS A consecutive series of 141 patients with MS referred from neurologists for primary neuro-urological work-up including urodynamics were prospectively evaluated. Clinical parameters taken into account were age, sex, duration, and clinical course of MS and Expanded Disability Status Scale (EDSS). RESULTS Multivariate modeling revealed EDSS as a clinical parameter significantly associated with urodynamic risk factors for upper urinary tract damage (odds ratio = 1.34, 95% confidence interval (CI) = 1.06-1.71, p = 0.02). Using receiver operator characteristic (ROC) curves, an EDSS of 5.0 as cutoff showed a sensitivity of 86%-87% and a specificity of 52% for at least one urodynamic risk factor for upper urinary tract damage. CONCLUSION High EDSS is significantly associated with urodynamic risk factors for upper urinary tract damage and allows a risk-dependent stratification in daily neurological clinical practice to identify MS patients requiring further neuro-urological assessment and treatment.
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Affiliation(s)
- Benjamin V Ineichen
- Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland/Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Marc P Schneider
- Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland/Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Martin Hlavica
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Michael Linnebank
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland/Department of Neurology, HELIOS-Klinik Hagen-Ambrock, Hagen, Germany
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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Guérard N, Zwingelstein C, Hoch M, Dingemanse J. Effect of Hepatic or Renal Impairment on the Pharmacokinetics, Safety, and Tolerability of Ponesimod, a Selective S1P1Receptor Modulator. Basic Clin Pharmacol Toxicol 2015; 118:356-68. [DOI: 10.1111/bcpt.12516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/20/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Nicolas Guérard
- Department of Clinical Pharmacology; Actelion Pharmaceuticals Ltd; Allschwil Switzerland
| | - Christian Zwingelstein
- Department of Clinical Pharmacology; Actelion Pharmaceuticals Ltd; Allschwil Switzerland
| | - Matthias Hoch
- Department of Clinical Pharmacology; Actelion Pharmaceuticals Ltd; Allschwil Switzerland
| | - Jasper Dingemanse
- Department of Clinical Pharmacology; Actelion Pharmaceuticals Ltd; Allschwil Switzerland
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