Purpose of ReviewMultiple sclerosis (MS) is the most frequent neuroinflammatory disease of the central nervous system and is commonly associated with lower urinary tract (LUT) dysfunction. As a consequence, health-related quality of life is often impaired and the upper urinary tract might be at risk for damage. The aim of this review is to give an overview of current treatment options for LUT dysfunction in patients with MS.Recent FindingsThe treatment is tailored to the type of dysfunction—storage or voiding dysfunction—beginning with conservative treatment options and ending with invasive therapies and surgery. Additionally, alternative options, e.g., different intravesical therapies or cannabinoids, have been evaluated in recent years with promising results.SummaryCurrent available therapies offer different possible treatments for LUT dysfunction in patients with MS. They address either voiding or storage dysfunction and therefore ameliorate LUT symptoms improve quality of life and protect the upper urinary tract.

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SummaryApoptotic cell death has been considered an underlying mechanism in acute lung injury. To evaluate the evidence of this process, apoptosis rate was determined in effector cells (alveolar macrophages, neutrophils) and target cells (tracheobronchial and alveolar epithelial cells) of the respiratory compartment upon exposure to hypoxia and endotoxin stimulation in vitro. Cells were exposed to 5% oxygen or incubated with lipopolysaccharide (LPS) for 4, 8 and 24 h, and activity of caspase-3, -8 and -9 was determined. Caspase-3 of alveolar macrophages was increased at all three time-points upon LPS stimulation, while hypoxia did not affect apoptosis rate at early time-points. In neutrophils, apoptosis was decreased in an early phase of hypoxia at 4 h. However, enhanced expression of caspase-3 activity was seen at 8 and 24 h. In the presence of LPS a decreased apoptosis rate was observed at 8 h compared to controls, while it was increased at 24 h. Tracheobronchial as well as alveolar epithelial cells experienced an enhanced caspase-3 activity upon LPS stimulation with no change of apoptosis rate under hypoxia. While increased apoptosis rate is triggered through an intrinsic and extrinsic pathway in alveolar macrophages, intrinsic signalling is activated in tracheobronchial epithelial cells. The exact pathway pattern in neutrophils and alveolar epithelial cells could not be determined. These data clearly demonstrate that upon injury each cell type experiences its own apoptosis pattern. Further experiments need to be performed to determine the functional role of these apoptotic processes in acute lung injury.

In contrast to the common notion of an acontractile detrusor during acute spinal cord injury, almost two-thirds of our patients showed unfavorable urodynamic parameters within the first 40 days after spinal cord injury. Considering that early treatment of neurogenic lower urinary tract dysfunction in patients with acute spinal cord injury might improve the long-term urological outcome, urodynamic investigation should be performed timely to optimize patient tailored therapy.

PURPOSE We investigated prevalence of asymptomatic bacteriuria and incidence of symptomatic urinary tract infections (UTI) in patients with neurogenic lower urinary tract dysfunction (NLUTD) undergoing urodynamics and assessed predictors for symptomatic UTI. PATIENTS AND METHODS A prospective consecutive series of 317 patients (106 women, 211 men) with NLUTD was evaluated. Of them, 111 (35%) voided spontaneously, 141 (44%) relied on intermittent self-catheterization and 65 (21%) on an indwelling catheter. Before urodynamics, urine samples were collected by sterile catheterization for dipstick testing and urine culture. We assessed the association between patient characteristics and the occurrence of symptomatic UTIs following urodynamics in patients with asymptomatic bacteriuria and developed a prediction model based on the most important risk factors. RESULTS Urine cultures before urodynamics were negative in 123 (39%) and positive in 194 (61%) patients. (32%) and e (18%) were the most frequent bacteria. Of 194 patients with positive culture, 35 (18%) had at least one symptomatic UTI. In patients with a history of previous UTIs, the overall estimated probability of a symptomatic UTI was 45%, irrespective of the underlying neurological disorder. CONCLUSIONS About one out of five patients with asymptomatic bacteriuria will develop a symptomatic UTI in the follow-up year. This rather low overall probability precludes routine antibiotic prophylaxis or treatment in patients with NLUTD having asymptomatic bacteriuria as 4 out of 5 patients would be overtreated. However, in patients with a history of previous symptomatic UTIs antibiotic prescription might be justified.

Purpose: We aimed to provide a real-world description of neurogenic lower urinary tract dysfunction within the first year after spinal cord injury with a focus on unfavorable urodynamic parameters that are associated with urological morbidity. Materials and Methods: Urodynamic investigations from 97 patients with traumatic or ischemic acute spinal cord injury and managed according to the European Association of Urology Guidelines on Neuro-Urology were analyzed at a single university spinal cord injury center at 1 month, 3 months, 6 months, and 12 months after injury. Unfavorable urodynamic parameters were defined as detrusor overactivity in combination with detrusor sphincter dyssynergia, maximum storage detrusor pressure of 40 cm H 2 O or higher, bladder compliance less than 20 mL/cm H 2 O, and vesicoureteral reflux of any grade. Results: One or more unfavorable urodynamic parameter was observed in 87 out of 97 patients (90%) within the first year after spinal cord injury. Eighty-eight percent of the patients showed detrusor overactivity with detrusor sphincter dyssynergia, 39% a maximum storage detrusor pressure of 40 cm H 2 O or higher, and 7% vesicoureteral reflux. No patient developed a low-compliance bladder. Conclusions: Using a standardized urodynamic follow-up schedule, we found unfavorable urodynamic parameters in a majority of the population within the first year after spinal cord injury. As early treatment based on urodynamic findings might reduce the risk of deterioration of upper and lower urinary tract function, thereby improving long-term outcomes, there is need for further research regarding recommendations for a urodynamic follow-up schedule during the first year after spinal cord injury.

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