The Treatment of Lower Urinary Tract Symptoms in Patients With Multiple Sclerosis: A Systematic Review

Abstract

This is a systematic review on the treatment of lower urinary tract symptoms (LUTS) in patients with multiple sclerosis (MS). The heterogeneity of the outcome criteria did not allow a meta-analysis of the published evidence. In the last few decades, the therapeutic options for neurogenic bladder dysfunction have broadened. Despite this, no consensus has been reached as to the management of LUTD and LUTS in patients with MS, and the subject remains controversial. Bladder dysfunction is common in MS, affecting 80 %-100 % of patients during the course of the disease. Several studies have shown that urinary incontinence has a severe effect on patients' quality of life, with 70 % of patients classifying the impact bladder symptoms had on their life as "high" or "moderate." Moreover, the progressive feature of MS makes its treatment complex, since any achieved therapeutic result may be short-lived, with the possibility that symptoms will recur or develop de novo.

Do Physical Therapy Interventions Affect Urinary Incontinence and Quality of Life in People with Multiple Sclerosis?

“…The reliability of the IIQ-7 and the UDI-6 have not been reported, although they have been used in multiple studies to record the impact of bladder dysfunction. 9 Individual effect sizes for each category of outcome measure were combined to calculate the grand statistics, and a 95% confidence interval was calculated. The data are presented in forest plots of within-and betweenstudy statistics.…”

“…After removing duplicates and irrelevant records, 42 full-text articles were Tubaro et al, 9 in a review of the management of incontinence in MS, made no discernible or definitive conclusions as treatment guidelines; standardization was hampered because of the heterogeneity of MS progression and bladder dysfunction. 9,25 To our knowledge, no meta-analysis has specifically reviewed PT interventions and increased QOL related to incontinence in the MS population.…”

“…9 The most commonly used management methods are anticholinergic therapies, followed by clean intermittent self-catheterization or permanent indwelling catheters. Catheters are usually reserved for patients with bladder atonia or underactive bladder.…”

“…The risk of infection with the use of catheters is compounded by the risk of hematuria and bladder or renal stones, as well as the hazard of urethral erosions in the long term. 9 Anticholinergic agents have limited success, lack efficacy, and are not well tolerated in the long term by people with MS. 9,24,25 Their documented adverse effects include constipation, xerophthalmia, and xerostomia. Incomplete voiding is also increased with the use of these drugs, 9,24 exacerbating existing symptoms and resulting in low compliance.…”

“…Although not all of these methods are routinely used clinically, conservative approaches described in the literature include clean intermittent self-catheterization or permanent indwelling catheters, anticholinergic agents, desmopressin, cannabinoids, complementary and alternative medicine, dorsal penile/clitoral nerve stimulation, and percutaneous posterior tibial nerve stimulation. 9,21,22 Minimally invasive surgical treatments involve sacral neuromodula-was completed, as well as a broad Google Scholar search to ensure that no relevant articles were missed. Two secondary reviewers (M.R., M.M.)…”