Neurourologic Abnormalities in Multiple Sclerosis

Abstract

Multiple sclerosis is a demyelinating disease of the central nervous system, often producing abnormalities in sexual function and urinary control. Eighty-six patients with this disorder were referred to our neurourologic facilities for evaluation (45 women and 41 men). Symptomatic voiding dysfunction was present in 84 patients (97 per cent). Sexual dysfunction was present in 29 of the 41 men (71 per cent). Neurourologic evaluation was performed by rapid-fill carbon dioxide cystometry and perineal floor needle electromyography. Several neurourologic patterns were identified in multiple sclerosis patients: the most common cystometry pattern was detrusor hyperreflexia (76 per cent) and the most common electromyography finding was vesico-sphincter dyssynergia (50 per cent). Voiding symptoms alone were not found to correlate with neurourologic findings. The presence of bilateral extensor plantar reflexes was found to indicate the possibility of vesico-sphincter dyssynergia. The addition of sacral-evoked responses to the neurourologic evaluation was useful in the identification and localization of occult sacral cord pathology and was of special significance to men with sexual dysfunction undergoing evaluation for neurogenic impotence. The combination of abnormal perineal electromyography, abnormal sacral latency and detrusor hyperreflexia was suggestive of multilevel spinal cord dysfunction and, possibly, has diagnostic as well as therapeutic significance. Neurourologic patterns were found to change in 4 of 9 patients re-evaluated because of symptom changes or poor treatment responses. Neurourologic testing in multiple sclerosis patients may be used to identify pathologic lesions, characterize sexual and voiding dysfunctions, corroborate neurologic diagnosis in doubtful cases and form a basis for rational treatment planning.

Urinary tract dysfunction in multiple sclerosis: is there a relation with disease-related parameters?

“…Therefore, a neurourological diagnostic evaluation seems to be mandatory both in patients with urological complaints and in those without symptoms. Few authors 6,7 studied the relationship between urological abnormalities and the severity and state of disability of the other features of multiple sclerosis. The aim of our study was to compare urodynamic behaviour with disease duration, physical examination, and disability status.…”

The Effect of Feedback on Penile Tumescence in Sexually Functional Men

“…Partial or total erectile dysfunction has been observed in between 50% to 70% of men with an established diagnosis of multiple sclerosis (Goldstein, Siroky, and Sax, 1982).…”

Use of intracavernous injection of prostaglandin E1 for neuropathic erectile dysfunction

“…8 Disc protrusion and herniation have been the cause of sacral and cauda equina com pression and variable degrees of associated erectile dysfunction.9 In addition ejaculat ory, voiding and bowel dysfunction may be observedlO if sacral outflow is affected.…”