PROVIDENCE, R.I. – More than a quarter of patients with multiple sclerosis report either current or previous urinary catheterization, with significantly higher rates reported for males than females, according to a survey of more than 9,600 patients.
"Although the development of voiding dysfunction and catheter use is common among patients with MS, rates of catheter use in this population was previously unknown," said Dr. Sangeeta T. Mahajan, division chief of female pelvic medicine and reconstructive surgery at University Hospitals, Case Medical Center (Cleveland).
Dr. Mahajan analyzed results from the Fall 2005 NARCOMS (North American Research Committee on Multiple Sclerosis) registry, which mailed surveys to 16,858 patients with MS. A total of 58% returned the survey and 26 patients were excluded because of prior major bladder surgery, leaving 9,676 responses. The group was primarily white (93%) and female (75%).
The survey revealed that 2,514 (26%) used a catheter at times, with 11% reporting current catheter use and 15% past use only. One-third of men had used a catheter, significantly more than did women (32% vs. 24%, P less than .001). Those who catheterized tended to have a longer history of MS (17.1 vs. 12.1 years, P less than .001); were more disabled, as measured by the PDDS (Patient Determined Disease Steps) scale; and had poorer quality of life, as measured by the SF-12 (Short Form–12 Quality of Life) inventory (P less than .001 in all components), she reported in a poster at the annual meeting of the American Urogynecologic Society.
The preferred method of catheterization differed between men and women. Men tended to prefer indwelling methods such as transurethral Foley catheterization (TFC) (47% males vs. 41% females, P = .003) or suprapubic catheterization (SPC) (12% vs. 6%, respectively, P less than .001). Overall, the most common methods of catheterization were intermittent self-catheterization (81%), followed by TFC (43%) and SPC (8%).
Overactive bladder symptoms, as indicated by a score of greater than 1 on the UDI-6 (Urogenital Distress Inventory), were more severe in those who catheterized (P less than .001). The exception was for severe nocturia, which was more frequent in those who did not catheterize.
Only 44% of the respondents had undergone urologic evaluation, including urodynamic testing (21%) and post-void residual screening (26%). Overall, 37% were prescribed an anticholinergic medication, although this percentage increased to 55% for those who catheterized (compared with 30% of those who did not catheterize, P less than .001). The medications used were generally older anticholinergics such as oxybutynin and tolterodine. A small fraction had undergone sacral neuromodulation (0.3%) or intradetrusor injection with onabotulinumtoxinA (0.9%).
Dr. Mahajan indicated she had no relevant disclosures.