Managing Urological Disorders in Multiple Sclerosis Patients: A Review of Available and Emerging Therapies

Bientinesi, Riccardo; Gandi, Carlo; Bassi, Pierfrancesco

doi:10.5213/inj.2040028.014

Cited by 10 publications

(12 citation statements)

References 66 publications

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“…Patients with MS can present lesions in any part of the CNS, although the spinal cord is most frequently affected. This explains the presence of neurogenic lower urinary tract dysfunction (NLUTD) in almost 80% of MS patients [ 10 , 11 ]. NLUTD usually occurs in advanced stages, but in 5 to 10% of MS patients can be seen in early stages [ 12 ].…”

Section: The Urologist’s Rolementioning

confidence: 99%

“…Diminished sexual function is often described in MS patients, and it is associated with more severe disability, pain and depression. Sexual function should be assessed during the follow-up and treatment options should be offered [ 10 ]. Although the assessment of sexual dysfunctions (SD) in MS patients is often underestimated, they are usually present and they have an important impact on QoL [ 24 , 25 ].…”

Section: The Urologist’s Rolementioning

confidence: 99%

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Neurologic Urinary Incontinence, Lower Urinary Tract Symptoms and Sexual Dysfunctions in Multiple Sclerosis: Expert Opinions Based on the Review of Current Evidences

Bientinesi

Gavi

Coluzzi

et al. 2022

JCM

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Objective: To resume each specialist’s role in the management of neurologic urinary tract symptoms (nLUTS) and sexual dysfunctions (SD) in patients suffering from multiple sclerosis (MS). Material and Methods: We asked a neurologist, a urologist and a gynecologist, experts on neuro-urology and sexual dysfunction at our hospital, to resume their role in the management of nLUTS and SD in MS patients based on the review of current evidence. PubMed was used to review literature with a focus on nLUTS and SD in MS patients. Conclusions: The difference in symptomatology in MS patients is very wide. The more the CNS is involved, the more the variations and severity of nLUTS is present. SD have numerous causes and should always be assessed. Urologists play the director’s role in evaluating and treating these patients. Neurologist should play an important role, they must evaluate the potential mutual interactions between disease manifestations of MS and their treatments. Additionally, gynecologists play an important information sharing role in the management of patients with multiple sclerosis.

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Section: The Urologist’s Rolementioning

confidence: 99%

Section: The Urologist’s Rolementioning

confidence: 99%

Neurologic Urinary Incontinence, Lower Urinary Tract Symptoms and Sexual Dysfunctions in Multiple Sclerosis: Expert Opinions Based on the Review of Current Evidences

Bientinesi

Gavi

Coluzzi

et al. 2022

JCM

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“…As scarce evidence on the use of AMs to treat NDO in patients affected by MS has been published, 13 in this study, we aimed to assess the efficacy, tolerability and safety of AM agents in a group of MS patients with storage LUTS.…”

Section: Introductionmentioning

confidence: 99%

“…AMs in MS patients have also been associated with a relatively high risk of urinary retention and current guidelines do not recommend AM in subjects with an increased post-void residual (PVR) and advise monitoring it when AM therapy is applied, with the combination of intermittent catheterisation if appropriate. [10][11][12] As scarce evidence on the use of AMs to treat NDO in patients affected by MS has been published, 13 in this study, we aimed to assess the efficacy, tolerability and safety of AM agents in a group of MS patients with storage LUTS.…”

Section: Introductionmentioning

confidence: 99%

Antimuscarinics for neurogenic overactive bladder in multiple sclerosis: real-life data

Andretta¹,

Agrò

Calabrese

et al. 2022

Therapeutic Advances in Urology

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Background: Antimuscarinics (AMs) represent the mainstay of treatment for storage lower urinary tract symptoms (LUTS) but few data are available on their impact in multiple sclerosis (MS) patients. Objective: To assess effectiveness and tolerability of AMs in MS patients with neurogenic detrusor overactivity (NDO). Methods: Sixty consecutive outpatients, who started treatment with AMs at one centre, were recruited. The primary endpoint was change in Patient’s Perception of Intensity of Urgency Scale (PPIUS) at 6 months; secondary endpoints were post-void residual urine (PVR) and pads used daily. Incidence and severity of adverse events (AEs) were recorded. Results: Significant reduction ( p < 0.001) of mean PPIUS and pads use were detected, as well as a significant increase ( p < 0.001) of PVR (143 ± 42 ml). AEs, recorded in 53% of patients, were frequently multiple and caused suspension of AM in 10% of cases, mainly for xerostomia, which has been the commonest AE (26.6%). Neurological AEs appeared in 11.7% of subjects, mostly with oxybutynin. Worsening/onset of voiding LUTS, reported by 8.3% of MS, resulted to be the unique AE correlated to AM dosage. Conclusion: This study suggests that AMs are effective in MS patients, but their use should be tailored on every patient as even low dosages can be poorly tolerated. AEs, including neurological ones, are common.

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“…In stress urinary incontinence, the mechanism is characterized by use a conscious contraction before or during increases in intra-abdominal pressure, and a building up a structural support (Di Benedetto et al, 2008). In urgency urinary incontinence, the biological rationale is that an involuntary detrusor contraction can be reflexively or voluntarily inhibited by pelvic floor muscle activation, therefore, voluntary pelvic floor muscle contraction may be used to control urgency (Bientinesi et al, 2020;Di Benedetto et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Pelvic floor muscle exercise and training for coping with urinary incontinence

Cho¹,

Kim²

2021

J Exerc Rehabil

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The pelvic floor consists of levator ani muscles including puborectalis, pubococcygeus and iliococcygeus muscles, and coccygeus muscles. Pelvic floor muscle exercise (PFME) is defined as exercise to improve pelvic floor muscle strength, power, endurance, relaxation, or a combination of these parameters. PFME strengthens the pelvic floor muscles to provide urethral support to prevent urine leakage and suppress urgency. This exercise has been recommended for urinary incontinence since first described by Kegel. When treating urinary incontinence, particularly stress urinary incontinence, PFME has been recommended as first-line treatment. This article provides clinical application of PFME as a behavioral therapy for urinary incontinence. Clinicians and physical therapist should understand pelvic floor muscle anatomy, evaluation, regimen, and instruct patients how to train the muscles properly.

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Managing Urological Disorders in Multiple Sclerosis Patients: A Review of Available and Emerging Therapies

Cited by 10 publications

References 66 publications

Neurologic Urinary Incontinence, Lower Urinary Tract Symptoms and Sexual Dysfunctions in Multiple Sclerosis: Expert Opinions Based on the Review of Current Evidences

Neurologic Urinary Incontinence, Lower Urinary Tract Symptoms and Sexual Dysfunctions in Multiple Sclerosis: Expert Opinions Based on the Review of Current Evidences

Antimuscarinics for neurogenic overactive bladder in multiple sclerosis: real-life data

Pelvic floor muscle exercise and training for coping with urinary incontinence

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