Tract Dysfunction In Multiple Sclerosis Research Articles

Neuro-urological diagnostics and treatment of non-traumatic/degenerative neurogenic lower urinary tract dysfunction exemplified by multiple sclerosis

Neurogenic lower urinary tract dysfunction in multiple sclerosis is often underestimated, underdiagnosed, and inadequately treated. Depending on the course of the disease and the location of neural damage, it occurs with varying frequency and types of impairment of urine storage and voiding function. Symptoms such as urinary incontinence, recurrent urinary tract infections, urgency, pollakiuria, reduced urinary flow, hesitancy as well as postvoid residual urine may occur. However, the symptoms do not allow any conclusions to be drawn about the underlying type of neurogenic lower urinary tract dysfunction. Although numerous data, publications, and guidelines are available on this topic today, there continues to be a lack of standardized screening parameters and algorithms that have been tested in prospective studies for multiple sclerosis. This article presents the current diagnostic and therapeutic options of neurogenic lower urinary tract dysfunction in multiple sclerosis. A crucial issue is the initial delay in diagnosis, not least due to a lack of communication between neurologists and urologists. Initial indicators of the presence of neurogenic lower urinary tract dysfunction can be obtained by actively asking about the subjective presence of symptoms such as urinary incontinence or the occurrence of urinary tract infections. However, a subjective lack of symptoms does not rule out a neurogenic lower urinary tract dysfunction. Regardless of the stage of the disease, an early and individualized neuro-urological diagnosis and treatment should be implemented. All aspects of the damage and the extent of functional deficits in other organ systems caused by multiple sclerosis must be included in this neuro-urological treatment decision, which requires a consistent interdisciplinary exchange between neurologists, general practitioners, and urologists. This interdisciplinary and interprofessional way of thinking and acting is key for an optimal treatment using the numerous therapeutic procedures. Lifelong, individual, risk-adapted urological care for the early detection and prevention of neuro-urological complications should be offered to persons with multiple sclerosis.

Challenges to Longitudinal Characterization of Lower Urinary Tract Dysfunction in Multiple Sclerosis

BackgroundNeurogenic lower urinary tract dysfunction (LUTD) results in lower urinary tract symptoms (LUTS) that impact quality of life in people with multiple sclerosis (PwMS). The risk factors and the contribution of LUTD to multiple sclerosis (MS) disease progression are under-researched. ObjectiveTo identify clinical and demographic predictors of LUTS in PwMS and gaps in clinical ascertainment. MethodsParticipants were adults with MS enrolled in a prospective, multicenter study (SUMMIT, N=802), including a subset of N = 258 patients in the UCSF EPIC study for whom medical records were further reviewed. Demographic (age, sex, race, ethnicity), clinical (disease duration, MS type), and female-specific reproductive factors (e.g., parity) were evaluated to determine associations with bowel/bladder functional system score. Participants’ medical records were analyzed to understand the patterns of LUTS ascertainment by physicians and the specific contribution of LUTS to overall bowel/bladder functional system scores. Results802 participants (71.3% female) contributed to these analyses. Higher bowel/bladder functional system scores, indicating worsening symptoms and function, were significantly associated with female sex (p=0.001) and progressive MS type (p≤ 0.001). In the EPIC participants, female-specific reproductive exposures (parity, menopause) were not significantly associated with worse bowel/bladder functional system scores. Most (98%) bowel/bladder functional system scores reflected the severity of LUTS (relative to bowel dysfunction). LUTS were under-ascertained clinically, and more so in women (X2 = 5.02, p=0.08). ConclusionsFemale sex and MS type are predictive of worsening LUTS. Symptoms may be less likely to be ascertained by clinicians in females compared to males.

Epidemiology and characteristics of urinary tract dysfunction in multiple sclerosis patients

Introduction. Data on the epidemiology and nature of neurogenic lower urinary tract dysfunction (NLUTD) in multiple sclerosis (MS) are contradictory: the prevalence rate ranges from 50 to 90% according to different authors.Purpose of the study. To assess the frequency and nature of urination disorders in patients with various forms of multiple sclerosis.Materials and methods. We analyzed the data of patients observed in the Regional Centre of Multiple sclerosis at Sverdlovsk Regional Clinical Hospital No. 1. The study included 160 patients aged 42.6±12.3 years, of which 64% were men and 36% were women. The primary progressive course of the disease occurred in 5% of patients, the secondary progressive course in 39%, and remitting in 56%. The average score according to the Expanded Disability Status Scale (EDSS) was 3.94±2.10. The nature of neurogenic dysfunction of the lower urinary tract was evaluated using questionnaires (NBSS, SF-Qualiveen) and urodynamic studies.Results. NLUTD were detected in 65% of MS patients. The average score according to the Neurogenic Bladder Symptom Scale (NBSS) in patients with NLUTD was 26.93±13.12, which was significantly (p < 0.001) exceed than the value of this indicator among patients without pelvic disorders (6.43±2.34). Symptoms of emptying were noted in more than half of patients with a neurogenic bladder in the presence of multiple sclerosis: poor urine flow (63%), abdominal straining during urination (76%). Complaints of storage symptoms, such as urgency and frequency, were presented by 98% of patients with neurogenic lower urinary tract dysfunction. Urinary incontinence was diagnosed in 84% of cases. The values of the «incontinence», «storage and voiding» and «complications» domains of NBSS were 8.66±7.17, 12.18±3.7 and 3.48±4.21, respectively. The total score of SF-Qaliveen questionnaire in patients with MS with urinary disorders was 2.93±1.13, in patients without NLUTD, 1.03±0.91 (р < 0,001).Conclusions. Neurogenic lower urinary tract dysfunction occurs in patients with multiple sclerosis with a frequency of 65%. These urinary disorders have a significant impact on the patients` quality of life.

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

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.

O11 Motor cortex versus sacral magnetic stimulation in lower urinary tract dysfunction in multiple sclerosis

Background Lower urinary tract dysfunction (LUTD) occurs in more than 75% of patients with Multiple Sclerosis (MS).There are few studies investigating effect of repetitive magnetic stimulation on LUTD in MS patients. Aim of the work Assess the effect of repetitive magnetic stimulation on the sacral roots versus motor cortex in MS patients with LUTD. Methods 40 MS patients with LUTD were divided into two groups (20 patients each); Group A (overactive bladder) and Group B (underactive bladder) according to urinary bladder dysfunction. Then, each group was further subdivided into Subgroup (I) received cortical magnetic stimulation and Subgroup (II) received sacral magnetic stimulation. Results In Group A (overactive bladder) patients; patients who received cortical magnetic stimulation showed a statistically significant reduction in maximum cystometric capacity (MCC) and post-void residual urine (PVR) together with a significant increase in maximum flow rate (Qmax). There was no statistically significant difference in I-QOL questionnaire score and detrusor pressure at maximum flow rate (Pdet@Qmax). Group (A) patients who received sacral magnetic stimulation showed a statistically significant reduction in MCC and Qmax. While there was no statistically significant difference in I-QOL questionnaire score, PVR or Pdet@Qmax. In Group B (underactive bladder) patients; patients who received cortical and patients received sacral magnetic stimulation showed a statistically significant reduction in I-QOL questionnaire score, post-void residual urine (PVR) and maximum cystometric capacity (MCC), with a significant increase in detrusor pressure at maximum flow rate (Pdet@Qmax) and maximum flow rate (Qmax). Conclusion 5 Hz sacral as well as cortical repetitive magnetic stimulation caused a significant decrease in MCC and increase in Pdet@Qmax which is expected to improve the underactive bladder symptoms, while it worsens the overactive bladder symptoms.

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.

Consensus guidelines on the neurologist's role in the management of neurogenic lower urinary tract dysfunction in multiple sclerosis

ObjectiveTo review current management of neurogenic lower urinary tract dysfunction (NLUTD) in MS patients and give recommendations on the joint role of the neurologist and urologist in NLUTD management. MethodsAn algorithm for evaluation and referral of MS patients to urologists was created. It is an outcome of discussions about current knowledge, existing guidelines, and key issues during two Belgian consensus meetings attended by neurologists, urologists and other stakeholders involved in MS management. At these meetings, updated information on management of NLUTD in MS was exchanged and the neurologists’ opinion on how to integrate this in the other aspects of care in MS patients was explored. ResultsShort evaluation of NLUTD in MS patients by neurologists and appropriate referral to urologists could accelerate proper diagnosis and treatment. Neurologists can play a central role in the inter-disciplinary communication on interactions between disease manifestations of MS and their treatments. ConclusionThe coordinating role of neurologists in NLUTD management may considerably improve QoL in MS patients. More research is needed to evaluate outcomes of urological assessments and treatment.

Management of lower urinary tract dysfunction in multiple sclerosis: A systematic review and Turkish consensus report

Since lower urinary tract dysfunction (LUTD) related to multiple sclerosis (MS) has a different behavior pattern than other types of neurogenic voiding dysfunction, we aimed to prepare a national consensus report for the management of LUTD due to multiple sclerosis in light of available literature. A search of available databases yielded an evidence base of 125 articles after the application of inclusion/exclusion criteria. When sufficient evidence existed, recommendations A (high), B (moderate), or C (low) were made according to the strength of evidence; recommendation D was provided when insufficient evidence existed. Available data did not support the use of invasive urodynamics in the initial evaluation of patients with MS and LUTD. Clinical studies on the safety and efficacy of antimuscarinics and alpha-blockers in these patients were scarce and low quality. Desmopressin could be used in MS-related overactive bladder symptoms owing to its short-term effects as an adjunctive treatment. Intravesical botulinum toxin type A treatment in patients with MS and detrusor overactivity was recommended in cases of medical treatment failure or severe side effects due to antimuscarinics. Pelvic floor rehabilitation together with neuromuscular electrical stimulation was also recommended as it increased symptomatic treatment success. This systematic review was not able to find any evidence-based cut off post-void residual value for the recommendation to start clean intermittent catheterization in MS-related LUTD. Patients with MS and LUTD could be best managed through the use of this consensus report.

Lower urinary tract dysfunction in multiple sclerosis, in Midi Pyrénées: Evaluation of a care network

Lower urinary tract dysfunction in multiple sclerosis, in Midi Pyrénées: Evaluation of a care network

Lower Urinary Tract Dysfunction in Multiple Sclerosis

Multiple sclerosis is commonly associated with bladder dysfunction, which is frequently reported to be the worst aspect of the disease. Patients may experience bothersome bladder symptoms early in the course, and this should be explored. If necessary, a formal evaluation of the lower urinary tract should be offered. The type of bladder dysfunction may also change with time, which highlights the need for continual follow-up assessments. Anticipated problems are incomplete bladder emptying and disorders with urine storage, which may occur simultaneously. This may lead to symptoms of overactive bladder and recurrent urinary tract infections. Conservative measures for management should be used initially while other sinister pathology is excluded. Newer treatments such as botulinum toxin A and neural stimulation techniques are replacing more invasive surgical procedures. Treatment approaches have been described and should be offered by teams who are familiar with patients having uro-neurological complaints.

Lower urinary tract dysfunction in MS: management in the community

Lower urinary tract dysfunction in multiple sclerosis is common and is highly amenable to treatment. Individuals may have bladder storage and/or voiding dysfunction. The risk of progression to renal failure is low and hence lower urinary tract dysfunction should be considered medically manageable in most individuals. Evaluation begins with history taking and is supplemented by using a bladder diary. Ultrasonography is used to assess the degree of incomplete bladder emptying, and for assessing upper urinary tract damage. Incomplete bladder emptying is most often managed by clean intermittent self-catheterization and should be initiated if post-void residual urine is greater than 100 mls. Storage symptoms are most often managed using antimuscarinic medications. Other options include desmopressin or detrusor muscle injection of botulinum toxin type A. There are specific situations where specialist urology services should be involved.

Neuromuscular electrical stimulation and the treatment of lower urinary tract dysfunction in multiple sclerosis— A double blind, placebo controlled, randomised clinical trial

Lower urinary tract dysfunction affects up to 75% of the multiple sclerosis population. Results from our recent Pilot Study (McClurg et al., 2006) indicated that a combined programme of pelvic floor muscle training, electromyography biofeedback and neuromuscular electrical stimulation modalities may alleviate some of the distressing symptoms within this population. This clinical trial aimed to evaluate further the efficacy of these interventions and to establish the benefit of neuromuscular electrical stimulation above and beyond that of EMG biofeedback and pelvic floor muscle training. 74 multiple sclerosis patients who presented with lower urinary tract dysfunction were randomly allocated to one of two groups - Group 1 received Pelvic Floor Muscle Training, Electromyography Biofeedback and Placebo Neuromuscular Electrical Stimulation (n=37), and Group 2 which received Pelvic Floor Muscle Training, Electromyography Biofeedback, and Active Neuromuscular Electrical Stimulation (n=37). Treatment was for nine weeks with outcome measures recorded at weeks 0, 9, 16 and 24. The Primary Outcome Measure was the number of leakage episodes. Within group analysis was by Paired Samples t-test. Group differences were analysed using Repeated Measures Analysis of Variance and Post-hoc tests were used to determine the significance of differences between Groups at each time point. The mean number of incontinence episodes were reduced in Group 2 by 85% (p=0.001) whereas in Group 1 a lesser reduction of 47% (p=0.001) was observed. However, there was a statistically superior benefit in Group 2 when compared to Group 1 (p=0.0028). This superior benefit was evident in all other outcome measures. The addition of Active Neuromuscular Electrical Stimulation to a programme of Pelvic Floor Muscle Training and Electromyography Biofeedback should be considered as a first-line option in alleviating some of the symptoms of lower urinary tract dysfunction associated with multiple sclerosis.

Effects of motor cortex rTMS on lower urinary tract dysfunction in multiple sclerosis

We tested the effects of 5-Hz rTMS over the motor cortex in multiple sclerosis (MS) subjects complaining of lower urinary tract symptoms either in the filling or voiding phase. Our data show that motor cortex stimulation for five consecutive days over two weeks ameliorates the voiding phase of the micturition cycle, suggesting that enhancing corticospinal tract excitability might be useful to ameliorate detrusor contraction and/or urethral sphincter relaxation in MS patients with bladder dysfunction. Multiple Sclerosis 2007; 13: 269–271. http://msj.sagepub.com

Do Alpha-Blockers Have a Role in Lower Urinary Tract Dysfunction in Multiple Sclerosis?

Lower urinary tract dysfunction is a major cause of morbidity in patients with multiple sclerosis. alpha 1-Adrenergic receptors are present at the bladder neck, where increased tone may be responsible for urinary retention and diminished flow rates. A randomized placebo controlled study was designed to test the hypothesis that blockade of these receptors using the selective alpha 1-adrenergic receptor antagonist indoramin would improve bladder emptying in patients with multiple sclerosis. Peak and mean urinary flow rates, residual volume and symptom score were evaluated at trial entry and again after 4 weeks in 18 men with multiple sclerosis. There was a mean 41 percent improvement in peak flow rate in the actively treated group compared with a 7.4 percent deterioration in the placebo group (p less than 0.05). Residual volume improved in both groups. Patients taking indoramin reported a greater improvement in urinary symptoms. Modulation of the alpha 1-receptor may have a role in the management of lower urinary tract dysfunction in multiple sclerosis.

Do Alpha-Blockers Have a Role in Lower Urinary Tract Dysfunction in Multiple Sclerosis?

Do Alpha-Blockers Have a Role in Lower Urinary Tract Dysfunction in Multiple Sclerosis?

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.