Neurogenic lower urinary tract dysfunction in multiple sclerosis, neuromyelitis optica, and related disorders.

Abstract

Multiple sclerosis (MS), neuromyelitis optica (NMO), and related disorders are major immune-mediated central nervous system diseases affecting the spinal cord. We reviewed the occurrence of neurogenic lower urinary tract dysfunction (NLUTD) in these categories of diseases. We systematically reviewed the literature regarding bladder dysfunction in MS, NMO spectrum disorder (NMOSD), and related disorders (acute disseminated encephalomyelitis, acute immune-mediated myelopathy, and meningitis-retention syndrome). The literature, although somewhat limited for diseases other than MS, suggests that bladder dysfunction is not uncommon in these diseases, presumably reflecting lesions in the spinal descending and ascending pathways. The pattern of bladder dysfunction is a combination of overactive bladder and large post-void residuals/urinary retention. Post-void residual is measured by portable ultrasound devices. Because of the complexity of bladder behavior, careful consideration of bladder management is necessary in MS, NMO, and related disorders: e.g., antimuscarinics, etc., for overactive bladder and clean, intermittent self-catheterization for urinary retention. These management practices should help improve patients' quality of life.