The Impact of Urodynamic Findings on Fatigue and Depression in People with Multiple Sclerosis

<b>Background</b>: Fatigue and depression are common symptoms of multiple sclerosis (MS) that severely impair quality of life. The factors influencing both are of increasing interest for establishing therapeutic synergisms. Correlations between the symptoms of neurogenic lower urinary tract dysfunction (NLUTD), fatigue, and depression have been described, but the impact of pathological urodynamic study (UDS) findings has not been investigated to date. <b>Method</b>: This retrospective, observational study correlated UDS findings of 274 people with MS (PwMS), prospectively collected between February 2017 and September 2021, with scores on the Fatigue Scale for Motor and Cognitive Functions and the German version of the Centre for Epidemiologic Studies Depression Scale. The effects of abnormal UDS on the FSMC and ADS scores were examined. Abnormal UDS was defined as follows: first desire to void (FDV) < 100 mL, strong desire to void < 250 mL (SDV), abnormal sensation, detrusor overactivity, detrusor-sphincter dyssynergia, reduced cystometric bladder capacity < 250 mL (MCBC), and compliance < 20 mL/cm H₂O (C_low). <b>Results</b>: PwMS with C_low (mean difference 3.21, 95% CI 0.25; 6.17, <i>p</i> = 0.036) or FDV < 100 mL (mean difference 2.61, 95% CI 0.1; 5.12, <i>p</i> = 0.041) had significantly higher FSMC mean values than those without. PwMS with MCBC < 250 mL (relative risk 1.06, 95% CI 1.02; 1.1, <i>p</i> = 0.006) or C_low (relative risk 1.06, 95% CI 1.02; 1.1, <i>p</i> = 0.004) had an increased risk of clinically relevant fatigue. No effects were found for depression. <b>Conclusions</b>: PwMS with NLUTD have higher FSMC scores and an increased risk of fatigue in our retrospective study. The assessment of prospective longitudinal data regarding the effect of successfully treated NLUTD on fatigue is important for utilising therapeutic synergisms for improved quality of life in PwMS.