Multiple sclerosis (MS) patients are commonly evaluated with magnetic resonance imaging (MRI) to identify/categorize lesion location and with urodynamic (UDS) testing to better understand bladder symptoms.   It has been well established that many MS patients are bothered by overactive bladder, underactive bladder and/or obstruction from detrusor sphincter dyssynergia (1).    We hypothesized that the location and type of MRI lesions would be associated with specific UDS findings among MS patients who had bothersome urinary symptoms.

We retrospectively reviewed records of MS patients with bothersome urinary symptoms who had been evaluated with both an MRI and a UDS evaluation between 2010-2017.  All patients were followed by a neurologist and neuro-urologist specializing in MS care.  MRI studies were re-evaluated by the MS neurologist categorized by lesion localization, the presence of T1, T2 and post-contrast lesions.  All urodynamic studies had been performed with a standardized protocol by FPMRS trained faculty and were re-reviewed for by a single neuro-urologist.  Urinary quality of life (QOL) was assessed by Michigan Incontinence Symptom Index (M-ISI) and American Urological Association Symptom Score (AUASS).  Associations were examined with SPSS statistical software.

We identified 31 MS patients with both UDS and MRI studies.   Mean patient age was 58 years (range 31-84) and mean time with MS was 20 years (range 5-41).  The most common MRI lesion locations were the cervical spine (45% of patients), brainstem (32%), supratentorial cerebrum (26%), thoracic spine (26%), and cortical cerebrum (16%).  The average number of lesions/study was 2.  T2 weighted lesions were more commonly seen compared to T1 (Figure 1).   The most common UDS findings were detrusor overactivity (73%), and detrusor sphincter dyssynergia (43%).   Low compliance (<12 cc/cm H20) was also demonstrated in 10% and detrusor atony in 3%.  Mean AUASS and ISI total/bother scores for cohort were 14/3  and 13/3.   

Presence of T2 lesions on MRI was associated with detrusor over activity on urodynamics (p=0.03) in this cohort.  T1 findings, post contrast findings or CNS location of lesions were not associated with any other specific UDS findings such as DSD, low compliance, detrusor underactivity (p<0.05).  When examining associations with urinary quality of life, type of MRI lesion (T1 or T2) and CNS location of lesion were not associated with moderate/severe AUASS or ISI scores.

The association between T2 lesions on MRI and urodynamically proven detrusor overactivity can be used to better coordinate MS patient care pathways.  Specifically, MS patients with T2 MRI lesions can be identified, assessed for symptoms, and started on an OAB pathway to help improve quality of life.  We were not able to draw any further associations between MRI and urodynamic findings.  Sample size limits generalization of findings, but there is no clear CNS anatomic location on MRI that can can be associated with bladder physiology in these MS patients.  This suggests bladder control is a complex phenomenon and may require more dynamic imaging studies to better understand the disease impact on bladder physiology among MS patients.

In this group of MS patients with MRI and urodynamics evaluations, the number of MRI T2 lesions was associated with detrusor overactivity on urodynamics.  These findings can potentially be used to identify MS patients from MRI imaging who may be symptomatic from overactive bladder symptoms and streamline treatment pathways for bothersome urinary symptoms.  There were no other associations found between specific MRI lesion locations, UDS findings, or Quality of life scores.

Stoffel JT.  Chronic Urinary Retention in Multiple Sclerosis Patients: Physiology, Systematic Review of Urodynamic Data, and Recommendations for Care.  Urol Clin North Am.  2017 Aug;44(3):429-439.  doi: 10.1016/j.ucl.2017.04.009. Review