Historical and Current Concepts Regarding Urodynamics in Multiple Sclerosis Patients

Abstract

In this review, current literature on management of neurogenic bladder in patients with multiple sclerosis (MS) is summarized. Topics include a review of MS, a brief overview of general treatment options, the effects of MS may manifest on lower urinary tract symptoms (LUTS), and clinical assessment of these patients. The utility of urodynamic evaluation in this patient population and the use of antibiotic prophylaxis in patients with MS on immunomodulatory medications are reviewed. Unlike neurogenic bladder in spinal cord patients, lower urinary tract dysfunction in MS patients rarely leads to upper urinary tract deterioration. Currently there is no consensus on imaging as a screening tool to assess renal deterioration in this patient population. Internationally, there are differing opinions on the necessity of performing invasive urodynamic (UDS) investigation in MS patients during initial assessment. However, UDS evaluation can be useful in the guidance of treatment options and patient counseling and prior to more invasive interventions. Depending on the severity of MS, lower urinary tract symptoms are common and can evolve with progression of the disease. Although individual guidelines exist for management of patients with MS and select aspects of neurogenic LUTS, an optimal guideline for initial evaluation and surveillance is not available. The evaluation of patients with MS reporting LUTS should be uniquely tailored and take into consideration individual symptoms, disease course, comorbidities, and medications. Additionally, MS patients on immunomodulation medications that undergo UDS should be considered for prophylactic antibiotics.