Association between Neurogenic Bladder Symptom Score and Disability Status in Multiple Sclerosis Patients

Lower urinary tract symptoms (LUTS) remain one of the most prevalent and disabling clinical manifestations in multiple sclerosis (MS) patients, often emerging early in the disease course and significantly impacting quality of life. Despite this, their relationship with neurological disability—as measured by the Expanded Disability Status Scale (EDSS)—remains insufficiently characterized in daily urological practice. Our study sought to clarify this clinical intersection using the Neurogenic Bladder Symptom Score (NBSS), a validated, MS-relevant tool for quantifying neuro-urological symptom burden.

In this cohort, we observed that higher NBSS total and domain scores were associated with greater neurological disability. Patients with EDSS ≥5—representing a clinically meaningful threshold linked with greater motor, functional, and urological involvement—demonstrated more pronounced LUTS, particularly in storage and incontinence domains. Although the strength of correlation was modest, the consistency across domains underscores the clinical relevance of this relationship.

Importantly, our findings reinforce that while EDSS remains the gold standard for quantifying neurological impairment, NBSS captures symptom severity from the perspective of bladder dysfunction—information not always reflected in traditional neurological scales. In real-world practice, urologists often evaluate MS patients without an immediately available EDSS—especially in settings where multidisciplinary care is fragmented. In such scenarios, NBSS may serve as a practical adjunct to estimate neuro-urological involvement, identify patients at risk of progression, and guide timely referral to neurology or specialized urodynamic evaluation.

Our results also highlight that broad conclusions regarding quality of life must be made cautiously; although patients with higher disability tended to report worse bladder-related burden, not all quality-of-life measures reached statistical significance. This nuance reflects the heterogeneous clinical expression of MS and underscores the importance of individualized patient assessment.

Ultimately, our study supports the integration of structured symptom assessment tools—such as NBSS—into the routine evaluation of MS patients. Rather than replacing neurological disability scales, NBSS complements them by offering a symptom-centered perspective that is highly relevant to urological practice. Future studies incorporating longitudinal designs, neuroimaging correlates, and urodynamic parameters may further elucidate the mechanistic links between neurological progression and bladder dysfunction.

Written by: Ana Silvia Vidal Brandt, MD, Instituto Mexicano del Seguro Social, UMAE Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Centro Médico Nacional Siglo XXI, Servicio de Urología, Ciudad de México, Cuauhtémoc, México

Read the Abstract

Login