PURPOSE: The purpose of this study was to determine the prevalence of stress urinary incontinence (SUI) in women with multiple sclerosis (MS) and to what degree these women are bothered by their SUI, since there is a paucity of literature regarding the nature of SUI in this unique population of women. METHODS: We conducted a prospective Institutional Review Board approved study. Women scheduled for outpatient follow-up appointments at a dedicated MS center were asked to complete a questionnaire regarding urinary incontinence. Urgency urinary incontinence (UUI) and SUI were defined as an answer of slightly, moderately or greatly to the Urogenital Distress Inventory (UDI-6) question #2 and question #3, respectively. Impact of SUI on physical activity was determined by Incontinence Impact Questionnaire (IIQ-7) question #2. RESULTS: A total of 55.9% (80/143) women had SUI, 70.6% (101/143) women had UUI, and 44.8% (64/143) women had mixed urinary incontinence. The mean age was 45.8 years old (range, 20 to 72 years). Women with SUI were significantly older (mean, 47.2 vs. 41.9; P=0.023) and there was a trend towards a greater body mass index (mean, 29.3 vs. 26.5; P=0.057). Women with SUI had significantly higher IIQ-7 scores compared to women without SUI (P<0.001). Impact of urinary incontinence on physical activity was also found to be significantly greater in women with SUI (mean IIQ-7 question #2, 0.96 vs. 0.35; P<0.001). CONCLUSIONS: The prevalence of SUI in women with MS is 55.9% and the presence of SUI has a significant impact on their quality of life. A comprehensive urologic evaluation of a woman with MS should include assessment of SUI.
Appointments and Schedules ; Body Mass Index ; Ethics Committees, Research ; Female ; Follow-Up Studies ; Humans ; Motor Activity ; Multiple Sclerosis ; Outpatients ; Prevalence ; Prospective Studies ; Quality of Life ; Urinary Incontinence

Purpose: Urgency urinary incontinence (UUI) is a common finding in patients with a history of stroke or cerebrovascular accident (CVA). UUI is associated with impaired quality of life as well as increased morbidity, mortality, and need for institutionalization. Medical therapy is often limited by side effects and/or cost prohibitiveness. As a result, third-line therapy is often implemented. The objective is to determine the efficacy of sacral neuromodulation (SNM) and onabotulinum toxin (BTX) in the management of post-CVA UUI. Methods: Retrospective analysis was performed to identify patients with post-CVA UUI who underwent SNM or BTX at a large academic medical center. The primary outcome was patient symptom response to third-line therapy. Treatment response was determined using the global response assessment scale. Patients reporting >50% improvement were categorized as having significant response. Secondary endpoints were proportion of patients achieving total dry and duration of therapy for those achieving significant response. Results: One hundred seventy-seven patients were identified (95 BTX, 82 SNM). Patients in the BTX group were older (71.9 years vs. 67.4 years, P=0.02) with otherwise similar demographics. Rate of symptom improvement to >50% of baseline was similar between the groups (66% of BTX, 61% of SNM, P=0.46) as was rate of patients experiencing total dryness (24% of BTX, 16% of SNM, P=0.17). Among patients achieving significant improvement there was no difference in continuation of therapy between the BTX and SNM groups. Younger age was identified as a predictor of >50% symptom improvement (odds ratio, 0.96; P=0.04) and treatment discontinuation (hazard ratio, 0.97; P=0.04) in SNM. Most common adverse events were urinary tract infection in BTX (11%) and pain in SNM (4%). Conclusions BTX and SNM show roughly equal efficacy in the management of post-CVA UUI with nearly two-thirds of patients achieving significant benefit.

Purpose: Urgency urinary incontinence (UUI) is a common finding in patients with a history of stroke or cerebrovascular accident (CVA). UUI is associated with impaired quality of life as well as increased morbidity, mortality, and need for institutionalization. Medical therapy is often limited by side effects and/or cost prohibitiveness. As a result, third-line therapy is often implemented. The objective is to determine the efficacy of sacral neuromodulation (SNM) and onabotulinum toxin (BTX) in the management of post-CVA UUI. Methods: Retrospective analysis was performed to identify patients with post-CVA UUI who underwent SNM or BTX at a large academic medical center. The primary outcome was patient symptom response to third-line therapy. Treatment response was determined using the global response assessment scale. Patients reporting >50% improvement were categorized as having significant response. Secondary endpoints were proportion of patients achieving total dry and duration of therapy for those achieving significant response. Results: One hundred seventy-seven patients were identified (95 BTX, 82 SNM). Patients in the BTX group were older (71.9 years vs. 67.4 years, P=0.02) with otherwise similar demographics. Rate of symptom improvement to >50% of baseline was similar between the groups (66% of BTX, 61% of SNM, P=0.46) as was rate of patients experiencing total dryness (24% of BTX, 16% of SNM, P=0.17). Among patients achieving significant improvement there was no difference in continuation of therapy between the BTX and SNM groups. Younger age was identified as a predictor of >50% symptom improvement (odds ratio, 0.96; P=0.04) and treatment discontinuation (hazard ratio, 0.97; P=0.04) in SNM. Most common adverse events were urinary tract infection in BTX (11%) and pain in SNM (4%). Conclusions BTX and SNM show roughly equal efficacy in the management of post-CVA UUI with nearly two-thirds of patients achieving significant benefit.

Purpose: Urgency urinary incontinence (UUI) is a common finding in patients with a history of stroke or cerebrovascular accident (CVA). UUI is associated with impaired quality of life as well as increased morbidity, mortality, and need for institutionalization. Medical therapy is often limited by side effects and/or cost prohibitiveness. As a result, third-line therapy is often implemented. The objective is to determine the efficacy of sacral neuromodulation (SNM) and onabotulinum toxin (BTX) in the management of post-CVA UUI. Methods: Retrospective analysis was performed to identify patients with post-CVA UUI who underwent SNM or BTX at a large academic medical center. The primary outcome was patient symptom response to third-line therapy. Treatment response was determined using the global response assessment scale. Patients reporting >50% improvement were categorized as having significant response. Secondary endpoints were proportion of patients achieving total dry and duration of therapy for those achieving significant response. Results: One hundred seventy-seven patients were identified (95 BTX, 82 SNM). Patients in the BTX group were older (71.9 years vs. 67.4 years, P=0.02) with otherwise similar demographics. Rate of symptom improvement to >50% of baseline was similar between the groups (66% of BTX, 61% of SNM, P=0.46) as was rate of patients experiencing total dryness (24% of BTX, 16% of SNM, P=0.17). Among patients achieving significant improvement there was no difference in continuation of therapy between the BTX and SNM groups. Younger age was identified as a predictor of >50% symptom improvement (odds ratio, 0.96; P=0.04) and treatment discontinuation (hazard ratio, 0.97; P=0.04) in SNM. Most common adverse events were urinary tract infection in BTX (11%) and pain in SNM (4%). Conclusions BTX and SNM show roughly equal efficacy in the management of post-CVA UUI with nearly two-thirds of patients achieving significant benefit.