Perspectives on urological care in multiple sclerosis patients

Abstract

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. Lower urinary tract dysfunction due to MS includes a dysfunction of the storage phase or dysfunction of the voiding phase or a detrusor-sphincter dyssynergia. Baseline evaluation includes a voiding chart, an ultrasound scan of the urinary tract, urine culture, and an urodynamic study. For storage symptoms, antimuscarinics are the first-line treatment, and clean intermittent catheterization (CIC) is indicated if there is concomitant incomplete bladder emptying. Intradetrusor injections with botulinum toxin A (BTX-A), are recommended for refractory cases. Urinary diversion is rarely indicated. For patients with voiding symptoms, CIC and alpha-blockers are usually offered. Sexual dysfunction in patients with MS is multifactorial. Phosphodiesterase type 5 inhibitors are first-line therapies for MS-associated erectile dysfunction in both male and female patients. This review summarizes the epidemiology, pathogenesis, risk factors, genetic, clinical manifestations, diagnostic tests, and management of MS. Lastly, the urologic outcomes and therapies are reviewed.

Keywords: lower urinary tract dysfunction; multiple sclerosis; neurogenic bladder; urology.

Figure 1.

The Pathogenesis of MS. MS, multiple sclerosis; Tregs, Regulatory CD4⁺ T cells; CNS, central nervous system.

Figure 2.

Algorithm for the management of storage symptoms in MS patients. MS, multiple sclerosis; UUI, urge urinary incontinence; SIC, self-intermittent catheterization; PVR, post void residual volume; BTX-A, Botulinum toxin A.