Journal Article

Management of neurogenic bladder in patients with multiple sclerosis

Panicker, Jalesh N., Phé, Véronique, Chartier–Kastler, Emmanuel

2016

Overview

Key Points Lower urinary tract (LUT) symptoms are common in patients with multiple sclerosis; the exact symptoms vary in type and severity, and can evolve with progression of the disease The management of LUT dysfunction in these patients requires a consensual approach, with cooperation between different medical professionals, and should take into consideration possible progression of the disease Intermittent self-catheterization is essential for the management of patients with voiding symptoms, but might also have a role in management of those with storage symptoms Intradetrusor botulinum toxin A injections are a highly effective and minimally invasive treatment of storage dysfunctions Surgical options include augmentation cystoplasty, cutaneous continent diversion and ileal conduit surgery, and should be performed only after careful selection of patients Multiple sclerosis has a progressive course and, therefore, patients with multiple sclerosis who also have LUT symptoms require regular long-term follow-up monitoring Lower urinary tract symptoms (LUTS) occur in >80% of patients with multiple sclerosis, have a substantial negative effect upon patients' quality of life and require regular monitoring owing to the progressive nature of the underlying neurodegenerative disease. In this Review, the authors describe the optimal diagnosis, treatment and management of the wide variety LUTs that can occur in patients with multiple sclerosis. Lower urinary tract (LUT) dysfunction is common in patients with multiple sclerosis and is a major negative influence on the quality of life of these patients. The most commonly reported symptoms are those of the storage phase, of which detrusor overactivity is the most frequently reported urodynamic abnormality. The clinical evaluation of patients' LUT symptoms should include a bladder diary, uroflowmetry followed by measurement of post-void residual urine volume, urinalysis, ultrasonography, assessment of renal function, quality-of-life assessments and sometimes urodynamic investigations and/or cystoscopy. The management of these patients requires a multidisciplinary approach. Intermittent self-catheterization is the preferred option for management of incomplete bladder emptying and urinary retention. Antimuscarinics are the first-line treatment for patients with storage symptoms. If antimuscarinics are ineffective, or poorly tolerated, a range of other approaches, such as intradetrusor botulinum toxin A injections, tibial nerve stimulation and sacral neuromodulation are available, with varying levels of evidence in patients with multiple sclerosis. Surgical procedures should be performed only after careful selection of patients. Stress urinary incontinence owing to sphincter deficiency remains a therapeutic challenge, and is only managed surgically if conservative measures have failed. Multiple sclerosis has a progressive course, therefore, patients' LUT symptoms require regular, long-term follow-up monitoring.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/699/2768/1337 / 692/699/375/1666 / 692/700/565/545 / 692/700/565/545/488 / Analysis / Bladder / Bladder diseases / Care and treatment / Complications and side effects / Cystoscopy - methods / Diagnosis / Disease Management / Health aspects / Humans / Intubation / Medicine & Public Health / Multiple sclerosis / Multiple Sclerosis - complications / Multiple Sclerosis - physiopathology / Multiple Sclerosis - therapy / Neurology / Quality of Life / review-article / Risk factors / Spinal cord / Urinary Bladder, Neurogenic - etiology / Urinary Bladder, Neurogenic - physiopathology / Urinary Bladder, Neurogenic - therapy / Urinary incontinence / Urine / Urodynamics - physiology / Urogenital system / Urology