The Management of Lower Urinary Tract Dysfunction in Multiple Sclerosis

Tornic, Jure; Panicker, Jalesh N.

doi:10.1007/s11910-018-0857-z

Cited by 65 publications

(48 citation statements)

References 97 publications

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“…The pattern of LUTS and LUTD is influenced by the lesion distribution in the neuroaxis. 5 In particular, lesions of the subcortical white matter, brain stem, and white matter in the spinal cord affect neural networks controlling LUT function, leading to neurogenic detrusor overactivity (DO). 5…”

Section: Introductionmentioning

confidence: 99%

Relationship between Lower Urinary Tract Dysfunction and Dementia

Cho

2020

Dement Neurocogn Disord

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Lower urinary tract dysfunction (LUTD) is a common health challenge in dementia patients with significant morbidity and socioeconomic burden. It often causes lower urinary tract (LUT) symptoms, restricts activities of daily life, and impairs quality of life. Among several LUT symptoms, urinary incontinence (UI) is the most prominent storage symptom in the later stages of dementia. UI in patients with dementia results not only from cognitive impairment, but also from urological defects such as detrusor overactivity. Management of LUTD in patients with dementia is based on multiple factors, including cognitive state, functional impairment, concurrent comorbidities, polypharmacy and urologic condition. Behavioral therapy under caregiver support represents appropriate treatment strategy for UI in these patients. Pharmacological treatment can be considered in patients refractory to behavioral therapy, but it is more effective when combined with behavioral therapy. Antimuscarinics and mirabegron, a beta-3 receptor agonist, are effective for managing storage symptoms involving the LUT. However, anticholinergic side effects in elderly subjects are a concern, particularly when there is a risk of exacerbating cognitive impairment with prolonged use of antimuscarinics. Proper recognition and treatment of LUTD in dementia can improve quality of life in these patients.

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Section: Introductionmentioning

confidence: 99%

Relationship between Lower Urinary Tract Dysfunction and Dementia

Cho

2020

Dement Neurocogn Disord

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“…Approval was obtained by our internal Institutional Review Board and Ethics Board. According to aforementioned published recommendations of expert physicians,5 8 14 15 we routinely questioned all MS Center patients seen from 3 September 2016 to 13 April 2017, to determine the presence or absence of urgency, frequency and retention, along with enough information concerning frequency of incontinence and need for catheterisation to classify each patient according to the ‘functional systems score’ (FSS) for bladder function, of the expanded disability status score 18. We also recorded the presence or absence of UUT pathology (eg, nephrolithiasis, hydronephrosis) and urinary tract infections (UTIs) within the prior year.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, patients with MS require ongoing surveillance and management of NLUTD symptoms, and in advanced cases are referred to a neurourologist. The topic of NLUTD has received much attention in the last few decades, and there are well-articulated guidelines in literature for NLUTD screening in patients with MS that include bladder ultrasound and baseline urodynamics among other measures 4–9…”

Section: Introductionmentioning

confidence: 99%

“…Upper urinary tract (UUT) pathology in patients with MS is rare compared with patients with spinal cord injury or spina bifida 10. There are some recommendations suggesting baseline renal ultrasound (RUS) for all patients with MS,11–13 or at least for patients with MS and NLUTD symptoms 5 8 14 15. Some authors propose more selective RUS screening and follow-up, only for MS patients with identified high risk of renal deterioration 1 16 17.…”

Section: Introductionmentioning

confidence: 99%

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Is baseline routine renal ultrasound indicated for all MS patients?

Títoff

Scott

2019

Postgraduate Medical Journal

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BackgroundMost patients with multiple sclerosis (MS) develop multiple urological complaints due to hyperactive or hypoactive bladder, and may have detrusor-sphincter dyssynergia. Routine renal ultrasound (RUS) screening has been recommended for both symptomatic and asymptomatic MS patients; however, there is little data to support this practice.MethodsProspectively screened consecutive MS clinic patients in 2016–2017 with functional systems scores (FSS) indicating moderate to severe neurogenic bladder symptoms (FSS bladder ≥2) were sent for RUS. We also screened for history of urinary tract infections.Results872 patients were screened between 3 September 2016 and 13 April 2017. 58 patients met inclusion criteria for RUS. 6 were excluded due to non-compliance with testing or unavailability of results; 52 patients were imaged. Only 3/52 patients were found to have renal pathology requiring follow-up. Of those three, one had known symptomatic nephrolithiasis, and one had subsequently normal findings, leaving one patient newly found to have valid abnormal upper urinary tract (UUT) findings. Multiple incidental findings were also discovered.ConclusionThe minimal yield for significant UUT pathology found in this enriched group of symptomatic MS patients indicates that RUS screening for asymptomatic MS patients without clear risk factors is not indicated. Red flags for high risk of UUT complications should be used as triggers for baseline RUS screening in MS patients.

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“…Mirabegron, alpha-1 blockers, desmopressin, phosphodiesterase type 5 inhibitors and cannabinoids are the other agents that may be useful in overactive bladder symptoms. Botulinum toxin-A, vanilloids, and oxybutynin are the intravesical treatment alternatives (45). More invasive treatment options can be used in cases resistant to all these treatments.…”

Section: Sacral Neuromodulationmentioning

confidence: 99%

Invasive Therapies in Multiple Sclerosis

Uzunköprü

2018

Archives of Neuropsychiatry

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Multiple sclerosis is a progressive disease despite so many recent therapy agents. Many symptoms can be seen that can affect the quality of daily life, such as spasticity, urinary incontinence, sensory disturbances, and tremor. These complaints may be refractory to the medical treatments, and the invasive treatment methods may be the only option to improve the quality of life of the patient. Intrathecal baclofen pump therapy can effectively reduce the spasticity in a patient with an inadequate response to oral baclofen. On the other hand, deep brain stimulation significantly reduces tremor and can provide the patient to eat by his/her self. Sacral neuromodulation may be beneficial in a patient with a history of urge incontinence which doesn't respond to oral agents. Adequate pain control can be achieved with spinal cord stimulators when a patient is unresponsive to the neuropathic pain treatment. Common features of all these invasive therapies are that they are used in patients who do not respond to medical treatments, they have a small number of randomized controlled clinical trial, and almost all of them are incompatible with MRI devices. According to the latest researches, more randomized controlled clinical trials and MRI compatible devices have been produced in recent years. We wanted to discuss these treatment methods even they have not yet been used routinely. We think they would be beneficial in clinical practice after their deficiencies have been overcome.

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The Management of Lower Urinary Tract Dysfunction in Multiple Sclerosis

Cited by 65 publications

References 97 publications

Relationship between Lower Urinary Tract Dysfunction and Dementia

Relationship between Lower Urinary Tract Dysfunction and Dementia

Is baseline routine renal ultrasound indicated for all MS patients?

Invasive Therapies in Multiple Sclerosis

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