Bladder In Multiple Sclerosis Research Articles

Posterior tibial nerve stimulation as a neuromodulation therapy in treatment of neurogenic overactive bladder in multiple sclerosis: A prospective randomized controlled study

Backgroundone of the major annoying disorders occurring in people with multiple sclerosis is lower urinary tract disorders (LUT). Urgency is considered the main one seriously influencing the quality of life. Neurogenic detrusor over activity (DOAB) is characterized by a hyperreflexic, overactive detrusor that responds quickly to low-intensity sensory input from general visceral afferent fibers. Overactivity has been claimed to induce random, uncontrolled contractions of the detrusor muscle, leading to intravesicular pressure rise, producing urgency, frequency, and consequently incontinence AimTo demonstrate the therapeutic efficacy for posterior tibial nerve stimulation (PTNS) in neurogenic over active bladder (NOAB) in people with multiple sclerosis MethodsThe current trial is a prospective, randomized controlled study. Forty remitting relapsing males with MS with moderate NOAB symptoms were randomly assigned into two equal groups; control group (C) treated by selected therapeutic exercises program for strengthening pelvic floor muscles and an intervention group (ES) receiving an additional posterior tibial nerve electrical stimulation. Each session ranged from 45- 50 minutes, three days weekly for a month. Outcome measures were recorded before starting the treatment and after termination of the study intervention and included over active bladder symptoms score (OVBS) score, urodynamic parameters (uroflow, filling and voiding cystometry), and post voiding residual volume by abdominal ultrasound ResultsThere was a significant improvement of all voiding parameters compared to baseline and the group C except frequency of urgency incontinence. A significant decrease was detected in post-treatment mean episodes number of nighttime frequency, urgency, urgency incontinence (1.65 ± 0.93, 1.2 ± 0.52 and 1.5 ± 0.76) respectively of the ES group compared to that of group C (3.05 ± 1.09, 2.25 ± 0.71 and 2.25 ± 1.06) (P < 0.01). There was a significant decrease in median post-treatment OVBS score 3 (3-3) compared to group C median score 5 (6-4). A statistically significant improvement was observed of all urodynamic parameters (bladder capacity and compliance, Detrusor overactivity (DO), maximum flow rate and post voidal residual volume in the ES group compared to the group C ConclusionPTNS is a promising and potentially beneficial treatment option for NOAB symptoms in males with MS and superior to pelvic floor muscle training alone.

Feasibility and Efficacy of Transdermal Hypogastric Nerve Stimulation in Treatment of Overactive Bladder in Multiple Sclerosis: A Prospective Randomized Controlled Trial

Objective: To determine the feasibility and efficacy of transdermal hypogastric nerve stimulation by interferential current stimulation (IFCs) in the treatment of OABs in relapsing-remitting multiple sclerosis (RRMS). Material and Methods: Forty male RRMS patients with moderate overactive bladder symptoms were randomly assigned into two equal groups; the control group (G1) was treated with selected therapeutic exercises for strengthening the pelvic floor muscles, and the intervention group (G2) received the same regimen plus hypogastric nerve stimulation at T10-L2 by interferential current (IFC). In both groups, the duration of each session ranged from 40-45 minutes, three days weekly for a month. Pre and post treatment evaluation was done by Overactive bladder symptom score (OABSS) included (daytime frequency, nocturia, urgency, and urgency incontinence) and Urodynamics tests included (bladder capacity, maximum flow rate, bladder compliance, detrusor instability) and post voiding residual urine measurement by abdominal ultrasound. The effect of treatment on bladder capacity, maximum flow rate, post void residual, bladder compliance and OVBSS was investigated using a mixed MANOVA. The Mann Whitney test was used to evaluate the detrusor instability between groups, and the Wilcoxon signed ranks test was used to compare pre and post treatment in each group. The level of significance was set at p &lt; 0.05 for all statistical tests. Results: Showed that a significant increase in bladder capacity, bladder compliance, percentage of detrusor stability and maximal flow rate and a significant decrease in post void residual post treatment in comparison with pretreatment (p &lt; 0.05) in both groups. There was a significant decrease in the daytime and nighttime frequency and urgency post treatment compared with that pretreatment in both groups (p &gt; 0.001) while a significant decrease of urgency incontinence in the study group only post treatment compared with that pretreatment (p &gt; 0.001). Post treatment, there was a significant difference of the intervention group (G2) compared with that of the control group (G1) for all tested variables (P&lt; 0.05) except for the daytime frequency and percentage of detrusor stability (p &gt; 0.05). Conclusions: Transdermal hypogastric nerve stimulation using IFC could be considered a feasible treatment option for neurogenic OABs in multiple sclerosis patients.

Christmas tree bladder in multiple sclerosis

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Antimuscarinics for neurogenic overactive bladder in multiple sclerosis: real-life data.

Background:Antimuscarinics (AMs) represent the mainstay of treatment for storage lower urinary tract symptoms (LUTS) but few data are available on their impact in multiple sclerosis (MS) patients.Objective:To assess effectiveness and tolerability of AMs in MS patients with neurogenic detrusor overactivity (NDO).Methods:Sixty consecutive outpatients, who started treatment with AMs at one centre, were recruited. The primary endpoint was change in Patient’s Perception of Intensity of Urgency Scale (PPIUS) at 6 months; secondary endpoints were post-void residual urine (PVR) and pads used daily. Incidence and severity of adverse events (AEs) were recorded.Results:Significant reduction (p < 0.001) of mean PPIUS and pads use were detected, as well as a significant increase (p < 0.001) of PVR (143 ± 42 ml).AEs, recorded in 53% of patients, were frequently multiple and caused suspension of AM in 10% of cases, mainly for xerostomia, which has been the commonest AE (26.6%). Neurological AEs appeared in 11.7% of subjects, mostly with oxybutynin. Worsening/onset of voiding LUTS, reported by 8.3% of MS, resulted to be the unique AE correlated to AM dosage.Conclusion:This study suggests that AMs are effective in MS patients, but their use should be tailored on every patient as even low dosages can be poorly tolerated. AEs, including neurological ones, are common.

Therapeutic strategies of urinary disorders in MS. Practice and algorithms

ObjectiveReview the literature on therapeutic strategies and guidelines for the treatment of neurogenic bladder in multiple sclerosis. Material and methodA search on available articles on consensus, recommendations guidelines and algorithm of treatment of urinary tract dysfunction in multiple sclerosis. ResultsFive national consensus guidelines were recently published and proposed guidelines for the first and second line treatments. ConclusionMultiple sclerosis patients suffering from lower urinary tract disorders must benefit from an early diagnosis and simple first line evaluation and treatment. More complex and invasive evaluation in the neuro-urology unit is appropriate for patients who failed to first line treatment or in case of complications.

The urinary bladder in multiple sclerosis

The urinary bladder in multiple sclerosis

Neurogenic bladder in Multiple Sclerosis: Review and proposal of management guidelines

Les troubles vesico-sphincteriens sont extremement frequents dans la SEP, et ils sont responsables d’un retentissement fonctionnel lie aux consequences des desordres mictionnels sur la qualite de vie quotidienne et organique, secondaire aux complications des neurovessies sur l’appareil urinaire. Si l’impact fonctionnel et ses modes de prise en charge sont bien documentes dans la litterature, l’impact organique reste sous-evalue, et il n’existe pas de guide consensuel de prise en charge pratique visant a depister et a prevenir les complications uro-nephrologiques des neurovessies de la SEP. La premiere partie de notre travail avait pour objectif d’identifier, par une analyse exhaustive de la litterature, les facteurs influencant le pronostic des complications uro-nephrologiques dans la SEP. La seconde partie, realisee conjointement avec le GENULF (Groupe d’etude neurourologique de langue francaise) et rapportee ulterieurement, proposera des recommandations eclairees pour la surveillance a moyen et long terme des neurovessies dans la SEP conformement a la methodologie preconisee par l’ANAES.

Lower urinary tract dysfunction in multiple sclerosis

Previous investigators have shown that in multiple sclerosis failure to empty the bladder was secondary to detrusor-distal sphincter dyssynergia or areflexia. However, our urodynamic evaluation of 46 female and 43 male patients with multiple sclerosis revealed that 63 percent of patients failed to empty their bladders because of a hypocontractile detrusor, and only 6 percent had areflexia. Detrusor-distal sphincter dyssynergia (6%) and bladder neck obstruction (6%) were present in only 12 percent of patients. Hyperreflexia was common (78 %) and was associated with hypocontractility in 63 percent of patients. Urgency incontinence was significantly more common in females and voiding difficulty significantly more common in males. Sensation was also reduced in 74 percent of female and 77 percent of male patients. In conclusion, failure to empty the bladder in multiple sclerosis is most commonly associated with hypocontractility, and the combination of hyperreflexia and hypocontractility produces the symptoms of urgency and incomplete emptying.

Increase of S-100 immunoreactivity in the urinary bladder from patients with multiple sclerosis, an indication of peripheral neuronal lesion.

The Schwann cells in urinary bladder biopsies from multiple sclerosis patients and controls were examined by immunocytochemistry with an antiserum to S-100. S-100 immunoreactivity was found to be markedly increased in these tissues as compared with the controls, indicating a Schwann cell hyperplasia in the urinary bladder in multiple sclerosis. This finding suggests that local neuronal damage exists in the urinary bladder of patients with multiple sclerosis. Therefore, the concept of multiple sclerosis as a disease wholly of the central nervous system should be reexamined.

The bladder in multiple sclerosis.

The bladder in multiple sclerosis.

Survey of neurogenic bladder in multiple sclerosis.

Holland, Nancy J. R.N., M.A.; Wiesel-Levison, Phyllis R.N., B.S.; Schwedelson, Elaine S. Author Information

Review of neurogenic bladder in multiple sclerosis

Neurologic involvement of the urinary bladder and urethral sphincter in multiple sclerosis has been known for some time. Thirty-one patients with a proved diagnosis of multiple sclerosis were evaluated urologically for symptoms of urinary incontinence, retention, or urinary tract infection. On initial presentation, 27 (74 per cent) were found to have neurogenic bladders of which 23 (85 per cent) were of the uninhibited type. Electromyography of the periurethral striated muscle revealed vesicosphincter incoordination in 9 of the 19 patients studied. Approximately one-half of the patients with uninhibited bladders had uncoordinated sphincters. Modalities of treatment are discussed.

Effect of Electrical Stimulation of the Thoracic Spinal Cord on the Function of the Bladder in Multiple Sclerosis

We treated 40 patients who had multiple sclerosis and bladder symptoms with thoracic spinal cord electrical stimulation. Bladder and sphincter dysfunction was evaluated by cystometry and eleetromyography. Subjective improvement was noted in 77.5 per cent of the patients and documented improvement was found on cystometry and electromyography in 42.5 per cent. By electrical stimulation of the spinal cord we have demonstrated varying degrees of restoration of voluntary and reflex control of the bladder and sphincter.

THE BLADDER IN MULTIPLE SCLEROSIS.

THE BLADDER IN MULTIPLE SCLEROSIS.

The Urinary Bladder in Multiple Sclerosis

No AccessJournal of Urology1 Jul 1952The Urinary Bladder in Multiple Sclerosis S. Richard Muellner, Julius Loman, and Leo Alexander S. Richard MuellnerS. Richard Muellner More articles by this author , Julius LomanJulius Loman More articles by this author , and Leo AlexanderLeo Alexander More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)68189-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1952 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChait A, Pons T and Roland V (2018) Neurogenic Bladder Caused by Sacral Echinococcus CystJournal of Urology, VOL. 80, NO. 3, (183-185), Online publication date: 1-Sep-1958.Muellner S (2018) Special Problems of Urinary Control in Patients with Multiple SclerosisJournal of Urology, VOL. 73, NO. 2, (254-260), Online publication date: 1-Feb-1955. Volume 68Issue 1July 1952Page: 230-236 Advertisement Copyright & Permissions© 1952 by The American Urological Association Education and Research, Inc.MetricsAuthor Information S. Richard Muellner More articles by this author Julius Loman More articles by this author Leo Alexander More articles by this author Expand All Advertisement PDF downloadLoading ...