Neurourology in Multiple Sclerosis and Other Demyelinating Disorders

Abstract

Multiple sclerosis (MS) and other demyelinating disorders are common neurological pathologies that affect neural integrity and transmission of signals along nerves in the central nervous system (Brain and Spinal Cord). Majority of patients with MS will present with urinary symptoms during the filling phase, voiding phase or both. This constellation of symptoms is commonly referred to as neurogenic lower urinary tract symptoms (NLUTS). NLUTS and their progression in MS is diverse and dynamic as the underlying disease itself. Careful evaluation and individualized management is recommended for all MS patients with NLUTS while higher risk patients such as young men or those with secondary progressive disease require closer monitoring with more frequent urodynamic testings and renal function assessments. Management of MS patients with NLUTS is similar to that of other patients with neurogenic bladder, and options include careful selection of appropriate oral overactive bladder medication, intradetrusor injection of onabotulinum toxin A, catheterization, and rarely augmentation cystoplasty or urinary diversion.