Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb;39(2):762-770.
doi: 10.1002/nau.24276. Epub 2020 Jan 15.

Consensus document on the multidisciplinary management of neurogenic lower urinary tract dysfunction in patients with multiple sclerosis

José Medina-Polo  1 , José María Adot  2 , Marta Allué  3 , Salvador Arlandis  4 , Pedro Blasco  5 , Bonaventura Casanova  6 , Jorge Matías-Guiu  7 , Blanca Madurga  8 , Edwin-Roger Meza-Murillo  9 , Carlos Müller-Arteaga  10 , Breogán Rodríguez-Acevedo  9 , Jesús Vara  11 , María Carmen Zubiaur  12 , Luis López-Fando  13
Affiliations

Consensus document on the multidisciplinary management of neurogenic lower urinary tract dysfunction in patients with multiple sclerosis

José Medina-Polo et al. Neurourol Urodyn. 2020 Feb.

Abstract

Aim: Neurogenic lower urinary tract dysfunction (NLUTD) is very common in multiple sclerosis (MS) patients. Early diagnosis and treatment are crucial to avoid irreversible damage and improve quality of life. Our aim was to develop recommendations to improve NLUTD identification in MS patients, along with their referral and management.

Methods: A multidisciplinary group of 14 experts in the management of patients with MS and NLUTD (nine urologists, three neurologists, and two rehabilitators) was selected. A comprehensive review of the literature was undertaken and a set of recommendations was generated and submitted to a Delphi panel of 114 experts. Recommendations were presented according to the grade of agreement (GA).

Results: Early diagnosis in asymptomatic patients with risk factors for complications is recommended (GA 94%). Postvoid residual volume should be measured if changes in urinary symptoms (GA 87%), preferably ultrasound-guided (GA 86%). Early referral to urologist is recommended if urinary incontinence (GA 91%), significant post-void residual volume (94%), quality of life impairment (GA 98%) and recurrent urinary infections (GA 97%). The initial evaluation should include physical examination (GA 99%) and urodynamics including cystometry (GA 89%), pressure-flow study (90%) and electromyography (GA 70%). The panel recommends multidisciplinary collaboration (GA 100%) with a rehabilitation specialist and trained nurses in the management of NLUTD (GA 99%).

Conclusions: Multidisciplinary management for patients with NLUTD due to MS is advised, including urologists, neurologists, rehabilitation, and nurses. Panel recommends early diagnosis with post-void residual volume in symptomatic patients before referring to urologist and urodynamics when referred.

Keywords: consensus; multidisciplinary care; multiple sclerosis; neurogenic lower urinary tract dysfunction.

PubMed Disclaimer

References

REFERENCES

    1. Thompson AJ, Baranzini SE, Geurts J, Hemmer B, Ciccarelli O. Multiple sclerosis. Lancet. 2018;391(10130):1622-1636. https://doi.org/10.1016/S0140-6736(18)30481-1
    1. Magyari M, Sorensen PS. The changing course of multiple sclerosis: rising incidence, change in geographic distribution, disease course, and prognosis. Curr Opin Neurol. 2019;32(3):320-326. https://doi.org/10.1097/WCO.0000000000000695
    1. Oreja-Guevara C, Kobelt G, Berg J, Capsa D, Eriksson J. European multiple sclerosis platform. New insights into the burden and costs of multiple sclerosis in europe: results for Spain. Mult Scler. 2017;23(2_suppl):166-178. https://doi.org/10.1177/1352458517708672
    1. Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278-286. https://doi.org/10.1212/WNL.0000000000000560
    1. Blok B, Castro-Díaz D, Del Popolo G, et al. European Association of Urology (EAU) Guidelines on Neuro-urology. European Association Of Urology; 2019. http://uroweb.org/guideline/neuro-urology/

Publication types

MeSH terms

LinkOut - more resources