Voiding Dysfunction in Multiple Sclerosis

Abstract

Voiding dysfunction is a common and debilitating consequence of multiple sclerosis (MS). The prevalence and severity of voiding dysfunction increases with the increasing severity of MS, but even the mildest forms of the disease are associated with urinary symptoms in 30% of patients. Every component of the central nervous system is involved in regulating voiding; as a result, MS can lead to a wide variety of urinary symptoms and urologic complications. The effect of MS on voiding can be classified according to the resulting function of the bladder and the urethral sphincter during storage and emptying of urine. Therapy is targeted to the specific bladder and sphincter abnormalities that occur. The primary goals of therapy are prevention of injury to the upper urinary tract (kidneys), reduction in urinary tract infections, and maintenance of urinary continence. These goals can be achieved by interventions ranging from behavioral modification to major reconstructive surgery.

Lower urinary tract disorders in multiple sclerosis patients: prevalence, clinical features, and response to treatments

“…In our sample, although less frequent, detrusor underactivity cases are present. Our data are in line with current literature, in which detrusor overactivity and detrusor‐sphincter dyssynergia are the most frequent urodynamic alterations in patients with MS. 1 , 3 , 4 , 25 These alterations correlated with lesions in cortical areas controlling micturition or pyramidal tract with regard to detrusor overactivity and to alterations of pontine regulatory pathways for detrusor‐sphincter dyssynergia. 19 The fact that supra‐ and infratentorial and cervical lesions are much more frequent than those at the sacral or infrasacral level (associated instead with underactive detrusor), 19 explains the difference in frequency of the urodynamic patterns.…”

“…1,3 These various clinical features may appear isolated or in association. 4 Patients with high disability (with an Expanded Disability Status Scale [EDSS] 5 score > 6.5) and/or with progressive MS phenotype are more likely to present pathological urodynamic study. 6 Treatment choice should be based on the specific type of disorder presented by the patient.…”

“…Another common alteration is the detrusor‐sphincter dyssynergia, whose prevalence data are greatly influenced by the heterogeneity of the evaluation method among studies 1,3 . These various clinical features may appear isolated or in association 4 . Patients with high disability (with an Expanded Disability Status Scale [EDSS] 5 score > 6.5) and/or with progressive MS phenotype are more likely to present pathological urodynamic study 6 …”

Data-Driven Machine-Learning Quantifies Differences in the Voiding Initiation Network in Neurogenic Voiding Dysfunction in Women With Multiple Sclerosis

“…The loss of neural conduction along axonal pathways that occurs in MS is caused by autoimmune-driven demyelination often accompanied by edema worsening the neurologic impairment. Depending on the affected regions in the central nervous system, symptoms vary greatly [2], generally characterized by neurogenic lower urinary tract dysfunction (NLUTD) [3] and may include difficulty of initiation or maintenance of voiding (VD).…”

Comparative Randomized, Single‐Dose, Two‐Way Crossover Open‐Label Study to Determine the Bioequivalence of Two Formulations of Dalfampridine Tablets

“…This delay disturbs impulse transmission throughout the nerve cells, leading to numerous clinical consequences depending on the lesion's location. These manifestations include visual loss, numbness, weakness, imbalance, and bowel and bladder urgency . Nonetheless, walking disabilities are predominant in patients with MS .…”