1. International Neurourology Journal 2015;19:272-277
Association Between the Neurogenic Bladder
Symptom Score and Urodynamic Examination
in Multiple Sclerosis Patients With Lower Urinary Tract Dysfunction
Eugenia Fragalà1, Giorgio Ivan Russo1, Alessandro Di Rosa1, Raimondo Giardina1, Salvatore Privitera1, Vincenzo Favilla1, Francesco Patti2, Blayne Welk3, Sebastiano Cimino1, Tommaso Castelli1, Giuseppe Morgia1
1Department of Urology, University of Catania, Catania, Italy
2Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
3Division of Urology, Department of Surgery, Western University, London, ON, Canada
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (
org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2. International Neurourology Journal 2015;19:272-277
INTRODUCTION
Lower urinary tract dysfunction (LUTD) could be a common disorder in the multiple sclerosis (MS) patients.
Unfortunately, the global assessment of urological symptoms is very difficult to investigate and some patient- reported measures (PROMs) are not conclusive because PROMs were not developed for patients with neurogenic bladder dysfunction, they may be incomplete or inappropriate.
Neurogenic bladder symptom score (NBSS) have demonstrated that it could be used to evaluate neurogenic bladder dysfunction-related symptoms.
The aim of this study was to determine the relationship between the NBSS and urodynamic examination in MS patients and related LUTD.

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MATERIALS AND MRTHODS
We recruited 122 consecutive patients with MS in remission and LUTD from January 2011 to September who underwent their first urodynamic examination. Neurological impairment was assessed using the Expanded Disability Status Scale (EDSS) and bladder symptoms were studied with the NBSS.

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RESULTS
Median NBSS was 20.0 (interquartile range, 12.75–31.0).
Neurogenic detrusor overactivity (NDO) was discovered in 69 patients (56.6%). The concordance between patients with NDO and maximum detrusor pressure during involuntary detrusor contraction (PdetmaxIDC)≥20.0 cm H2O was 0.89 (κ-Cohen; P<0.05).
Patients with EDSS scores of ≥4.5 had a greater NBSS (25.41 vs , P<0.05), NBSS-incontinence (8.73 vs , P<0.05), NBSS-consequence (4.51 vs. 3.13, P<0.05) and NBSS-quality of life (2.14 vs. 1.65, P<0.05).
The NBSS was not associated with PdetmaxIDC≥20 cm H2O (P=0.77) but with maximum cystometric capacity<212 mL (odds ratio, 0.95; P<0.05).

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CONCLUSIONS
The NBSS cannot give adequate information the way urodynamic studies can, in patients with MS and LUTD.

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Characteristic
Value
Sex
 Male
50 (41.0)
 Female
72 (59.0)
Multiple sclerosis variants
 Relapsing remittent
85 (69.7)
 Primary progressive
15 (12.3)
 Secondary progressive
22 (18.0)
Age (yr)
46.0 (41.5–53.5)
EDSS
4.5 (2.9–6.0)
Duration of disease (mo)
156.0 (60.0–231.0)
HAM-A
12.0 (8.0–16.2)
HAM-D
13.0 (9.0–19.5)
NBSS total score
20.0 (12.75–31.0)
Incontinence subscale
0 (0.0–11.0)
Storage + voiding subscale
10.0 (7.75–13.0)
Consequences subscale
4.0 (1.0–6.0)
QoL item
2.0 (1.0–3.0)
NBSS ≥20
63 (51.6)
IIEF-15
41.5 (22.0–57.0)
 IIEF-EF
16.0 (7.7–24.0)
 IIEF-IS
7.0 (4.0–10.2)
 IIEF-OF
7.0 (2.0–10.0)
 IIEF-SD
7.0 (4.0–8.0)
 IIEF-OS
4.0 (2.0–8.0)
Male sexual dysfunction (IIEF-15<60)
40 (80.0)
FSFI
16.0 (2.0–25.5)
 FSFI-Desire
3.0 (1.2–4.8)
 FSFI-Arousal
2.1 (0.0–4.1)
 FSFI-Lubrication
2.1 (0.0–4.5)
 FSFI-Orgasm
1.2 (0.0–2.4)
 FSFI-Satisfaction
1.6 (0.0–4.0)
 FSFI-Pain
1.4 (0.0–6.0)
Female sexual dysfunction (FSFI<26.55)
48 (66.6)
Neurogenic detrusor overactivity
69 (56.6)
Detrusor underactivity
24 (17.8)
Detrusor sphincter dyssynergia
70 (51.9)
AOFC (cm H2O)
28.5 (21.4–44.5)
MCC (mL)
153.5 (125.0–220.3)
PdetmaxIDC (cm H2O)
34.7 (6.8–55.2)
VpmaxIDC (mL)
136.0 (99.0–170.0)
Compliance (mL/cm H2O)
10.2 (4.0–37.7)
Table 1. Demographics, neurological, sexual, and urodynamic characteristics of patients included in the study Values are presented as number (%) or median (interquartile range). EDSS, Expanded Disability Status Scale; HAM-A, Hamilton Anxiety Scale; HAM- D, Hamilton Depression Scale; NBSS, neurogenic bladder symptoms score; IIEF-15, International Index of Erectile Function; IIEF-EF, IIEF-erectile function; IIEF-IS, IIEF-intercourse satisfaction; IIEF-OF, IIEF-orgasmic function; IIEF-SD, IIEF-sexual desire; IIEF-OS, IIEF-overall satisfaction; FSFI, Female Sexual Function Index; AOFC, amplitude of the first overactive contraction; MCC, maximum cystometric capacity; PdetmaxIDC, maximum detrusor pressure during involuntary detrusor contraction (IDC); VpmaxIDC, volume at first IDC.

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Variable
NBSS < 20 (n = 59)
NBSS ≥ 20 (n = 63)
P-value
Age (yr)
47.5 (42.0–56.50)
46.0 (37.0–55.0)
0.578
Duration of disease (mo)
90.0 (60.0–165.0)
168.0 (36.0–216.0)
<0.01
EDSS
4.0 (2.0–5.0)
4.0 (3.5–7.5)
0.430
HAM-A
12.0 (8.25–23.0)
11.0 (8.0–23.0)
0.320
HAM-D
10.0 (8.50–19.0)
16.0 (9.0–22.0)
IIEF-EF
18.0 (8.5–24.7)
11.0 (5.0–17.0)
0.372
IIEF-IS
9.0 (4.5–11.7)
7.0 (3.0–9.0)
0.350
IIEF-OF
8.0 (2.0–10.0)
6.0 (2.0–9.0)
0.592
IIEF-SD
6.5 (4.5–8.0)
7.0 (6.0–8.0)
0.092
IIEF-OS
5.0 (2.0–8.0)
4.0 (2.0–4.0)
0.479
MCC (mL)
212.0 (130.0–357.0)
131.0 (117.0–225.0)
NDO, n (%)
26 (44.1)
37 (58.7)
0.620
PdetmaxIDC (cm H2O)
39.9 (6.2–76.2)
85.9 (63.6–104.0)
0.121
Compliance
10.8 (2.4–41.8)
3.3 (1.2–6.2)
0.357
FSFI
14.6 (1.5–27.3)
16.0 (2.0–25.7)
0.829
FSFI-Desire
3.3 (1.2–5.7)
3.0 (1.2–4.6)
0.167
FSFI-Arousal
2.1 (0.3–4.8)
3.0 (0–4.1)
0.328
FSFI-Lubrication,
2.4 (0–4.8)
3.4 (0–4.5)
0.021
FSFI-Orgasm
1.2 (0–2.3)
2.2 (0–3.5)
FSFI-Satisfaction
2.4 (0–4.6)
2.0 (0.2–3.9)
0.680
FSFI-Pain
1.4 (0–6.0)
1.6 (0–5.9)
0.467
Table 2. Clinical and urodyamics findings according to NBSS cutoff Values are presented as median (interquartile range) unless otherwise indicated. NBSS, neurogenic bladder symptoms score; EDSS, Expanded Disability Status Scale; HAM-A, Hamilton Anxiety Scale; HAM-D, Hamilton Depression Scale; IIEF, International Index of Erectile Function; IIEF-EF, IIEF-erectile function; IIEF-IS, IIEF- intercourse satisfaction; IIEF-OF, IIEF- orgasmic function; IIEF-SD, IIEF-sexual desire; IIEF-OS, IIEF-overall satisfaction; MCC, maximum cystometric capacity; NDO, neurogenic detrusor overactivity; PdetmaxIDC, maximum detrusor pressure during involuntary detrusor contraction; FSFI, Female Sexual Function Index.

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Table 3. Spearman correlation between variables
NBSS
Spearman rho
MCC
Pdetmax
PdetmaxIDC
Compliance
HAM-A
HAM-D
EDSS
FSFI
IIEF-15
Total score
–0.213*
–0.401**
–0.005
–0.086
0.447**
0.389**
0.278**
–0.228*
–0.194*
Incontinence
–0.154
–0.472**
–0.050
0.009
0.326**
0.302**
0.332**
–0.149
–0.219
Storage + voiding
–0.097
–0.200*
0.033
–0.127
0.369**
0.312**
0.121
–0.206
–0.186
Consequence
–0.197*
–0.028
–0.060
0.379**
0.384**
0.254**
–0.446**
–0.102
QoL
–0.291**
–0.229*
0.076
0.474**
0.408**
0.398**
–0.329**
–0.457**
NBSS, neurogenic bladder symptoms score; MCC, maximum cystometric capacity; Pdetmax, maximum detrusor pressure; PdetmaxIDC, Pdetmax during involuntary detrusor contraction; HAM-A, Hamilton Anxiety Scale; HAM-D, Hamilton Depression Scale; EDSS, Expanded Disability Status Scale; FSFI, Female Sexual Function Index; IIEF, International Index of Erectile Function; QoL, quality of life.
* P<0.05. ** P<0.01.