Neurogenic bladder in the multiple sclerosis population: A systematic review and meta-analysis of prevalence and a proposed evaluation algorithm

Abstract

BACKGROUND: Neurogenic bladder (NGB) is one of the most common and debilitating manifestations of multiple sclerosis (MS), substantially impairing quality of life and increasing the risk of secondary complications. OBJECTIVE: To determine the pooled prevalence of NGB and its subtypes in people with MS (PwMS). METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines and was prospectively registered in PROSPERO. The MEDLINE, Embase, Scopus, and Google Scholar databases were searched. Risk of bias was assessed using the ROBINS-E scale. Pooled prevalence estimates were calculated using a random-intercept generalized linear mixed model (GLMM) with logit transformation and Hartung-Knapp adjustment. Meta-regression and subgroup analyses were performed to explore heterogeneity, and sensitivity analyses included leave-one-out analysis and prediction intervals. RESULTS: Twenty-two studies comprising 39,304 PwMS were included. The pooled prevalence of NGB was 48.8% (95% CI: 34.1-63.7%). Subtype analyses showed pooled prevalences of 39.1% for storage symptoms, 21.4% for voiding symptoms, and 40.9% for mixed symptoms. Meta-regression did not identify significant associations between NGB prevalence and age, EDSS, or disease duration. Sensitivity and subgroup analyses indicated that heterogeneity (I² > 97%) was primarily attributable to differences in diagnostic definitions, assessment instruments, and study design rather than demographic or clinical characteristics. CONCLUSIONS: NGB affects approximately one in two PwMS with the prevalence ranging from 6 to 94%. Standardized screening and assessment strategies are warranted to improve early identification and optimize care pathways.