Introduction

Neurogenic lower urinary tract dysfunction (NLUTD) is a common presentation of multiple sclerosis (MS). MS NLUTD management progresses through a treatment ladder, largely driven by patient symptomatology, ranging from minimally invasive treatments up to surgery. There is a paucity of research regarding the time course and factors which may contribute to treatment escalation. The primary aim of this investigation was to characterize the time to surgery (TTS) in MS disease years and identify how subtypes of MS, mobility status, and intermediate treatments impact this timeline.

Methods

IRB approval was obtained for this study (HUM00232194). Data Direct was utilized to identify MS patients who underwent urinary diversion surgery at our institution between 2013 and 2023. Abstracted data included MS diagnosis date, MS type, disease timeline, and treatment modalities. Multiple linear regression was conducted to evaluate the association between independent variables and TTS. Statistical significance was set at p<0.05. Analyses were performed with SPSS Version 29.0.2.0.

Results

131 patients were initially identified and 20 patients met inclusion criteria: 15 (75%) were female, 17 (85%) had progressive MS, and 12 (60%) were wheelchair-bound. The average TTS was 22±9 (8-40) years and the mean patient age at surgery was 58±12 (37-80) years. Progressive MS was associated with an increase of 9.8 years in TTS (p=0.047). Botulinum toxin treatment was not associated with a change in TTS (p=0.211). Wheelchair status was associated with an increase of 9.0 years in TTS (p=0.013).

Conclusions

The average time from MS diagnosis to surgery was 22 years. To our knowledge, this is the first study characterizing the treatment escalation timeline for MS NLUTD. Patients with relapsing-remitting MS underwent surgery sooner than progressive MS patients, consistent with literature reports that relapsing-remitting patients experience greater degrees of bothersome symptoms. Patients with decreased mobility had prolonged TTS, suggesting that NLUTD symptoms are one of many factors contributing to surgical decision making. Collectively, these identified characteristics may be utilized to counsel patients of their potential management course based on their presenting MS phenotype.

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