Treatment of lower urinary tract symptoms in multiple sclerosis patients: Review of the literature and current guidelines

Abstract

Multiple sclerosis (MS) is a unique neurological disease with a broad spectrum of clinical presentations that are time-and disease course-related. Lower urinary tract symptoms (LUTS) are highly prevalent in this patient population, with approximately 90% showing some degree of voiding dysfunction and/or incontinence 6-8 years after the initial MS diagnosis. Major therapeutic goals include quality of life improvement and the avoidance of urological complicationsOwing to the wide divergence of clinical symptoms and disease course, evaluation and treatment differ between patients. Treatment must be customized for each patient based on disease phase, patient independence, manual dexterity, social support, and other medical-or MS-related issues. Ablative or irreversible therapies are indicated only when the disease course is stable. In most cases of "safe" bladder, behavioural treatment is considered first-line defense. Antimuscarinic drugs, alone or in combination with intermittent self-catheterization, are currently the mainstay of conservative treatment, and several other medications may help in specific disease conditions. Second-line treatment includes botulinum toxin A injection, neuromodulation, indwelling catheters, and surgery in well-selected cases.

Evaluation of Quality of Life among Patients with Multiple Sclerosis and voiding dysfunction: A Cross-Sectional Study

“…[31] Arhrony found that irritative (storage) symptoms are associated with EDSS and the involvement of pyramidal pathways, but this association is very weak with obstructive symptoms. [34] Furthermore, another study revealed that the scores of irritative and obstructive symptoms were significantly increased with EDSS scores; however, the correlation coefficient for the scores of irritative symptoms (r = 0.60, P < 0.0001) was higher than obstructive symptoms. [33] In some other studies, there was a direct correlation between the EDSS score and irritative or obstructive symptom score, [43,44] albeit no relationship was reported between these variables in the studies by Miller and Porru.…”

“…In this regard, the study by Sand et al also indicated that 60% of men and 50% of women with MS had reported mixed symptoms; [23] however, the results of the study by Aharony indicated that there was no significant correlation between the overall incidence of LUTS and gender. [34] The results of an investigation on 8284 men and women in China, Taiwan, and South Korea revealed that the prevalence of storage symptoms alone was higher among women compared to men (23.8% versus 12.6%, respectively) and obstructive symptoms alone had a rate of 7.2%. [35] However, due to the widespread nature of the lesions of the nervous system among patients with MS, numerous levels of control of the function of the bladder and intestine are observed, [6] and the nature of urination complaints and LUTS varies among patients with MS. [36] In addition, LUTS change over time along with the dynamic course of MS.…”

Evaluation of Quality of Life among Patients with Multiple Sclerosis and Lower Urinary Tract Symptoms: A Cross-Sectional Study

“…[28] Arhrony found that irritative (storage) symptoms are associated with EDSS and the involvement of pyramidal pathways, but this association is very weak with obstructive symptoms. [31] In some other studies, there was a direct correlation between the EDSS score and irritative or obstructive symptom score, [38,39] albeit no relationship was reported between these variables in the studies by Miller and Porru. [40,41] It seems that the differences in the results of different studies are due to the clinical course of MS which the patients under study were undertaking during the study period.…”

“…In this regard, the study by Sand et al also indicated that 60% of men and 50% of women with MS had reported mixed symptoms; [18] however, the results of the study by Aharony indicated that there was no significant correlation between the overall incidence of LUTS and gender. [31] The results of an investigation on 8284 men and women in China, Taiwan, and South Korea revealed that the prevalence of storage symptoms alone was higher among women compared to men (23.8% versus 12.6%, respectively) and obstructive symptoms alone had a rate of 7.2%. [32] However, due to the widespread nature of the lesions of the nervous system among patients with MS, numerous levels of control of the function of the bladder and intestine are observed, [8] and the nature of urination complaints and LUTS varies among patients with MS. [26] In addition, LUTS change over time along with the dynamic course of MS.…”

“…[36] In this regard, Wang found that the higher the EDSS score, the higher the possibility of LUTS. [31] Furthermore, the study by Khalaf et al suggested that patients with MS with immediate urgency and UI had significantly lower QOL in comparison to patients with MS without these symptoms. [45] The strengths of this study included the appropriate sample volume and suitable ratio of men to women based on the proportion of MS prevalence rate in society.…”