Semin Neurol 2016; 36(02): 212-218
DOI: 10.1055/s-0035-1571212
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Voiding Dysfunction in Multiple Sclerosis

Anton Wintner*
1   Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Michelle M. Kim*
1   Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Seth K. Bechis*
1   Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Evgeniy I. Kreydin
2   Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
› Author Affiliations
Further Information

Publication History

Publication Date:
26 April 2016 (online)

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.

* These authors contributed equally to this publication.


 
  • References

  • 1 de Sèze M, Ruffion A, Denys P, Joseph PA, Perrouin-Verbe B ; GENULF. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler 2007; 13 (7) 915-928
  • 2 Fowler CJ, Panicker JN, Drake M , et al. A UK consensus on the management of the bladder in multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80 (5) 470-477
  • 3 Tapia CI, Khalaf K, Berenson K, Globe D, Chancellor M, Carr LK. Health-related quality of life and economic impact of urinary incontinence due to detrusor overactivity associated with a neurologic condition: a systematic review. Health Qual Life Outcomes 2013; 11: 13
  • 4 Quarto G, Autorino R, Gallo A , et al. Quality of life in women with multiple sclerosis and overactive bladder syndrome. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18 (2) 189-194
  • 5 Thom DH, Nygaard IE, Calhoun EA. Urologic diseases in America project: urinary incontinence in women-national trends in hospitalizations, office visits, treatment and economic impact. J Urol 2005; 173 (4) 1295-1301
  • 6 Griffiths DJ, Fowler CJ. The micturition switch and its forebrain influences. Acta Physiol (Oxf) 2013; 207 (1) 93-109
  • 7 Holstege G. Descending motor pathways and the spinal motor system: limbic and non-limbic components. Prog Brain Res 1991; 87: 307-421
  • 8 Holstege G. The emotional motor system in relation to the supraspinal control of micturition and mating behavior. Behav Brain Res 1998; 92 (2) 103-109
  • 9 Mantyh PW. Forebrain projections to the periaqueductal gray in the monkey, with observations in the cat and rat. J Comp Neurol 1982; 206 (2) 146-158
  • 10 Holstege G, Griffiths D, de Wall H, Dalm E. Anatomical and physiological observations on supraspinal control of bladder and urethral sphincter muscles in the cat. J Comp Neurol 1986; 250 (4) 449-461
  • 11 Blok BF, Holstege G. Two pontine micturition centers in the cat are not interconnected directly: implications for the central organization of micturition. J Comp Neurol 1999; 403 (2) 209-218
  • 12 de Groat WC, Wickens C. Organization of the neural switching circuitry underlying reflex micturition. Acta Physiol (Oxf) 2013; 207 (1) 66-84
  • 13 Wein AJ. Pathophysiology and classification of lower urinary tract dysfunction: overview. In: A.J. Wein et al, eds. Campbell-Walsh Urology. Philadelphia, PA: Elsevier Saunders; 2012: 1834-1846
  • 14 Yang CC. Bladder management in multiple sclerosis. Phys Med Rehabil Clin N Am 2013; 24 (4) 673-686
  • 15 Wein AJ, Dmochowski RR. Neuromuscular dysfunction of the lower urinary tract. In: A.J. Wein et al, eds. Campbell-Walsh Urology. Philadelphia, PA: Elsevier Saunders; 2012: 1909-1946
  • 16 De Ridder D, Vermeulen C, De Smet E, Van Poppel H, Ketelaer P, Baert L. Clinical assessment of pelvic floor dysfunction in multiple sclerosis: urodynamic and neurological correlates. Neurourol Urodyn 1998; 17 (5) 537-542
  • 17 Litwiller SE, Frohman EM, Zimmern PE. Multiple sclerosis and the urologist. J Urol 1999; 161 (3) 743-757
  • 18 McGuire EJ, Cespedes RD, O'Connell HE. Leak-point pressures. Urol Clin North Am 1996; 23 (2) 253-262
  • 19 Araki I, Matsui M, Ozawa K, Takeda M, Kuno S. Relationship of bladder dysfunction to lesion site in multiple sclerosis. J Urol 2003; 169 (4) 1384-1387
  • 20 Giannantoni A, Scivoletto G, Di Stasi SM, Grasso MG, Vespasiani G, Castellano V. Urological dysfunctions and upper urinary tract involvement in multiple sclerosis patients. Neurourol Urodyn 1998; 17 (2) 89-98
  • 21 Betts CD, D'Mellow MT, Fowler CJ. Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis. J Neurol Neurosurg Psychiatry 1993; 56 (3) 245-250
  • 22 Giannantoni A, Scivoletto G, Di Stasi SM , et al. Lower urinary tract dysfunction and disability status in patients with multiple sclerosis. Arch Phys Med Rehabil 1999; 80 (4) 437-441
  • 23 De Ridder D, van Poppel H, Demonty L , et al. Bladder cancer in patients with multiple sclerosis treated with cyclophosphamide. J Urol 1998; 159 (6) 1881-1884
  • 24 Blaivas JG, Barbalias GA. Detrusor-external sphincter dyssynergia in men with multiple sclerosis: an ominous urologic condition. J Urol 1984; 131 (1) 91-94
  • 25 de Sèze M, Ruffion A, Denys P, Joseph PA, Perrouin-Verbe B ; GENULF. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler 2007; 13 (7) 915-928
  • 26 Kim YH, Goodman C, Omessi E, Rivera V, Kattan MW, Boone TB. The correlation of urodynamic findings with cranial magnetic resonance imaging findings in multiple sclerosis. J Urol 1998; 159 (3) 972-976
  • 27 McGuire EJ, Savastano JA. Urodynamic findings and long-term outcome management of patients with multiple sclerosis-induced lower urinary tract dysfunction. J Urol 1984; 132 (4) 713-715
  • 28 Pozzilli C, Grasso MG, Bastianello S , et al. Structural brain correlates of neurologic abnormalities in multiple sclerosis. Eur Neurol 1992; 32 (4) 228-230
  • 29 Andrews KL, Husmann DA. Bladder dysfunction and management in multiple sclerosis. Mayo Clin Proc 1997; 72 (12) 1176-1183
  • 30 Blaivas JG, Kaplan SA. Urologic dysfunction in patients with multiple sclerosis. Semin Neurol 1988; 8 (2) 159-165
  • 31 Davis R, Jones JS, Barocas DA , et al; American Urological Association. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol 2012; 188 (6, Suppl) 2473-2481
  • 32 Esteve J, Kricker A, Ferlay J, Parkin D. Cancer, Facts and figures of cancer in the European Community. Lyon, France: International Agency for Research on Cancer; 1993
  • 33 Gallien P, Nicolas B, Robineau S , et al. Urological complications in multiple sclerosis: study of risk factors. Ann Readapt Med Phys 1998; 41 (3) 155-158 . DOI:10.1016/S0168-6054(98)80014-7
  • 34 Amarenco G, Bosc S, Boiteau F. Les complications urologiques de la sclérose en plaques. 180 cas [Urologic complications of multiple sclerosis. 180 cases]. Presse Med 1996; 25 (22) 1007-1010
  • 35 Mahajan ST, Patel PB, Marrie RA. Under treatment of overactive bladder symptoms in patients with multiple sclerosis: an ancillary analysis of the NARCOMS Patient Registry. J Urol 2010; 183 (4) 1432-1437
  • 36 Klarskov P, Heely E, Nyholdt I, Rottensten K, Nordenbo A. Biofeedback treatment of bladder dysfunction in multiple sclerosis. A randomized trial. Scand J Urol Nephrol Suppl 1994; 157: 61-65
  • 37 Sand PK, Sand RI. The diagnosis and management of lower urinary tract symptoms in multiple sclerosis patients. Dis Mon 2013; 59 (7) 261-268
  • 38 Bragg R, Hebel D, Vouri SM, Pitlick JM. Mirabegron: a Beta-3 agonist for overactive bladder. Consult Pharm 2014; 29 (12) 823-837
  • 39 Sanford M. OnabotulinumtoxinA (Botox®): a review of its use in the treatment of urinary incontinence in patients with multiple sclerosis or subcervical spinal cord injury. Drugs 2014; 74 (14) 1659-1672
  • 40 Kilicarslan H, Ayan S, Vuruskan H, Gokce G, Gultekin EY. Treatment of detrusor sphincter dyssynergia with baclofen and doxazosin. Int Urol Nephrol 2006; 38 (3–4) 537-541
  • 41 Bushman W, Steers WD, Meythaler JM. Voiding dysfunction in patients with spastic paraplegia: urodynamic evaluation and response to continuous intrathecal baclofen. Neurourol Urodyn 1993; 12 (2) 163-170
  • 42 Denys P, Thiry-Escudie I, Ayoub N, Even-Schneider A, Benyahya S, Chartier-Kastler E. Urethral stent for the treatment of detrusor-sphincter dyssynergia: evaluation of the clinical, urodynamic, endoscopic and radiological efficacy after more than 1 year. J Urol 2004; 172 (2) 605-607
  • 43 Mehta S, Hill D, Foley N , et al; Spinal Cord Injury Rehabilitation Evidence Research Team. A meta-analysis of botulinum toxin sphincteric injections in the treatment of incomplete voiding after spinal cord injury. Arch Phys Med Rehabil 2012; 93 (4) 597-603
  • 44 Karsenty G, Baazeem A, Elzayat E, Corcos J. Injection of botulinum toxin type A in the urethral sphincter to treat lower urinary tract dysfunction: a review of indications, techniques and results. Can J Urol 2006; 13 (2) 3027-3033
  • 45 Gomelsky A, Coco CT, Dmochowski RR. Urinary incontinence in women: non-pharmacologic approaches and newer pharmacotherapies. Minerva Med 2014; 105 (4) 263-274
  • 46 Ghezzi A, Carone R, Del Popolo G , et al; Multiple Sclerosis Study Group, Italian Society of Neurology. Recommendations for the management of urinary disorders in multiple sclerosis: a consensus of the Italian Multiple Sclerosis Study Group. Neurol Sci 2011; 32 (6) 1223-1231