MS Speaks

Nat Rev Urol. 2016 Mar 31.

Management of neurogenic bladder in patients with multiple sclerosis.

Phé V1,2, Chartier-Kastler E1, Panicker JN2.

Author information

1Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance-Publique-Hôpitaux, 47-83 boulevard de l'hôpital, 75651 Paris Cedex 13, France.
2Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.

Lower urinary tract (LUT) dysfunction is common in patients with multiple sclerosis and is a major negative influence on the quality of life of these patients.

The most commonly reported symptoms are those of the storage phase, of which detrusor overactivity is the most frequently reported urodynamic abnormality.

The clinical evaluation of patients' LUT symptoms should include a bladder diary, uroflowmetry followed by measurement of post-void residual urine volume, urinalysis, ultrasonography, assessment of renal function, quality-of-life assessments and sometimes urodynamic investigations and/or cystoscopy.

The management of these patients requires a multidisciplinary approach. Intermittent self-catheterization is the preferred option for management of incomplete bladder emptying and urinary retention.

Antimuscarinics are the first-line treatment for patients with storage symptoms. If antimuscarinics are ineffective, or poorly tolerated, a range of other approaches, such as intradetrusor botulinum toxin A injections, tibial nerve stimulation and sacral neuromodulation are available, with varying levels of evidence in patients with multiple sclerosis.

Surgical procedures should be performed only after careful selection of patients.

Stress urinary incontinence owing to sphincter deficiency remains a ... challenge, and is only managed surgically if conservative measures have failed.

Multiple sclerosis has a progressive course. Therefore, patients' LUT symptoms require regular, long-term follow-up monitoring.