A Study of Urinary Tract Dysfunction in MS Patients Through Personalised Simulations
Lower urinary tract dysfunction is a common problem in patients with multiple sclerosis (MS). It is estimated that between 52%- 97% of MS patients develop these symptoms (Litwiller et al. (1999),J Urol ) which affect adversely their quality of life and sometimes cause serious morbidity and even mortality. The severity and management of urogenital symptoms correlate strongly with the degree of disability. A common management approach is catheterisation (intermittent or permanent), which often leads to recurrent urinary tract infections (UTIs). UTI management constitutes a significant cost to NHS due to frequent admissions to A&E.
Little is known about the fluid mechanics of a dysfunctional lower urinary tract such as that encountered in patients with MS.It is likely that the flow conditions in the bladder of these patients together with catheterisation provide an environment that favours bacteria growth. In the proposed study medical imaging and urodynamic studies will be combined with computer simulations (CFD) to study the fluid mechanics of the urinary tract of MS patients and the role of intervention. The effects of involuntary contractions or retained fluid will be studied for patients with varying degrees of disability to identify the existence of stagnation zones and to quantify the shear conditions for bacteria growth. The efficiency of management approaches such as catheterisation will be evaluated in order to establish best practise or criteria for catheter design. Finally an in vitro study using personalised phantoms will be conducted to serve as a validation for the simulations and to study bacteria growth.