Voiding dysfunction due to multiple sclerosis: a large scale retrospective analysis

Abstract

Purpose: To assess the outcome of urologic evaluation in patients with voiding dysfunction due to multiple sclerosis (MS) and to determine the relationship between urological and neurological parameters of these patients. Materials and Methods:We retrospectively reviewed the medical records of 249 consecutive patients (162 female and 87 male) with MS who were referred to our clinic between 1991 and 2006, with a median time of 4 years (range 3 months to urinary tract symptoms were evaluated by Boyarsky symptom index. Results: All patients except 13 had lower urinary tract symptoms and 70% manifested mixed symptoms. Total, storage and voiding symptom scores correlated with expanded disability status scale scores (p < 0.05). Twelve patients (5%) had -relation was found between urodynamic diagnosis and upper tract deterioration and urinary symptom scores (p > 0.05). Conclusions:The prevalence of mixed symptoms in patients with MS is higher than storage or voiding symptoms alone. Although detrusor overactivity and detrusor-sphincter dyssynergia were the most common urodynamic diagnoses, upper urinary tract deterioration was rare in our series.

Urinary dysfunction in women with multiple sclerosis: analysis of 61 patients from Rio de Janeiro, Brazil

“…20 reported a rate of 15.7% of female patients aged over 15 complaining of urinary incontinence in the general population, with a frequent association of symptoms like urinary urgency and nocturia. 6,16 Our result differs from findings in the general population showing a direct correlation between advanced age and frequency of urinary incontinence in women. 6,16 This finding reinforces the impact of MS disease on urinary dysfunction.…”

Sacral neuromodulation: an effective treatment for lower urinary tract symptoms in multiple sclerosis

“…These voiding difficulties have been shown to be related to a hypotonic and/or atonic detrusor, as well as a lack of coordination between the detrusor and urethral sphincter during voiding, also termed detrusor-sphincter dyssynergia (DSD) which often coexists with detrusor overactivity (DO) [4]. In view of the high intravesical pressure, chronic urinary retention and recurrent urinary tract infections (UTIs) are experienced by these patients, and upper urinary tract complications such as renal failure, pyelonephritis, hydronephrosis, and bladder and kidney stones have been described in 5 -10 % of patients with MS [3,7]. Further results have shown that if the DSD and chronic urinary retention are not treated, up to 50 % of patients with MS might develop the above complications [8,9].…”

Diagnosing detrusor sphincter dyssynergia in the neurological patient

“…Untreated DSD has been associated with reduced bladder compliance, elevated upper tract pressures, VUR, hydronephrosis and renal failure [ 3,5,14,15 ] . Complications of DSD occur less frequently in women and patients with MS, perhaps due to lower detrusor pressures [ 3,9,10 ] .…”

“…One report estimates that ≈ 75% of patients with suprasacral SCI have DSD [ 7 ] . The incidence of DSD in MS and spinal dysraphism is estimated at 25 -50% [ 9,10,12 ] .…”