Multiple Sclerosis (MS) is the most common demyelinating disease of the nervous system. Approximately 75% of patients with MS will present low urinary tract dysfunction (LUTD) during the course of the disease impacting their quality of life. The Neurogenic Bladder Symptom Score (NBSS) has been validated to assess urinary symptoms in three domains and quality of life in neurogenic patients. The aim of this study was to evaluate the impact of urinary symptoms in this group of patients on their quality of life, as well as their association with functional status using the Expanded Disability Status Scale (EDSS).

With the approval of the ethics committee of Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad, Hospital de Especialidades Centro Médico Nacional Siglo XXI in Mexico City, the Spanish version of the NBSS was applied prospectively to patients diagnosed with MS from the Neurology clinic. The EDSS score was also obtained.
The NBSS total score and by domains were compared with the EDSS less than 5 or greater than or equal to 5, and with the quality of life question. The cut-off point of the NBSS total score with better sensitivity and specificity was calculated and its association with the EDSS, quality of life, type of multiple sclerosis and time of diagnosis of the disease was analyzed. For all statistical comparisons significance was considered as p< 0.05.

We enrolled 116 consecutive patients with MS in remission, 78 women and 38 men, to answer the NBSS. A significant association was found for the EDSS with the NBSS total score (p=0.003), continence domain (p=0.01), storage and voiding domain (p=0.02), but not for the consequences domain (p=0.94). Thera was a significant association between the quality of life and the EDSS (0.038). In the multivariate analysis, the question of quality of life and the time of diagnosis of the disease are the best predictors for the total score (p<0.05). 28% of patients reported themselves as happy, 24% mostly satisfied, 18% satisfied as dissatisfied, 21% mostly dissatisfied and 9% unhappy. The NBSS cut-off point that is best associated with an EDSS less than 5 or greater than or equal to 5 was 19 points.

The findings of this study suggest that the NBSS is related to EDSS and quality of life in MS patients. 
It is known that MS is a neurological demyelinating that alters the neural function that is essential for normal urinary function. LUTD is very common in MS and can occur in different forms. Several PROMs have been introduced to identify possible patterns of LUTD. 
The NBSS has been designed specifically to assess signs and symptoms related to neurogenic bladder dysfunction and quality of life. In this study we showed that NBSS was significantly impaired by neurological disability (EDSS).  Also, we found an important association between the quality of life reported by the patient, with the NBSS total score and the EDSS.  
It is important to say that the Spanish version of the NBSS questionnaire has already been statistically tested.

The severity of urinary symptoms assessed by the NBSS in patients with MS is associated with the severity of the disease assessed by the EDSS and with their quality of life, making it an appropriate tool for the assessment and follow-up of patients in neurourological clinical practice.

Monti BM, et al. Lower urinary tract dysfunction in patients with multiple sclerosis: A post- void residual analysis of 501 cases. Multiple Sclerosis and Related Disorders 45 (2020) 102378
Eugenia Fragala`, et al. Association Between the Neurogenic Bladder Symptom Score and Urodynamic Examination in Multiple Sclerosis Patients With Lower Urinary Tract Dysfunction. Int Neurourol J 2015;19:272-277
Moreno PJ, et al. Cross-cultural adaptation and validation of the neurogenic bladder symptom score for Spanish speakers. Neurourology and Urodynamics. 2021;40:1939–1944.