[Urinary alterations in multiple sclerosis]

The neurourological disorders of the lower urinary tract occur during the course of multiple sclerosis. Their expression as irritative, obstructive or mixed symptoms, in accordance with the standardized terminology of the International Continence Society, varies in each patient and also during the course of the illness of each patient. These vesicourinary disorders reduce the quality of life and their complications worsen the prognosis for survival if they are not suitably treated.

We review the anatomical and physiological basis integrating and coordinating vesical sphincter function; the dynamics of micturition with its phases of filling and emptying, their coordination with the sphincters through the different centres and circuits of the nervous system; the physiopathology, in relation to the localization of the plaques of demyelination, of incontinence due to detrusor hyperreflexia, hyperreflexia with dyssynergia, hyperreflexia of the detrusor with hypoactivity of the detrusor during the emptying phase and finally due to areflexia. The symptomatology and clinical features vary from 60% to 80% in the different series of cases, depending on the time of evolution and degree to which the patients are affected, with a predominance of irritative rather than obstructive symptoms. The treatment, which requires precise classification of the disorders, is with anticholinergic drugs or alpha 1 blocking and myorelaxant drugs, surgery, neurostimulators, rehabilitation, catheterism, the use of absorbent and collectors, other techniques and therapies which are being developed, without forgetting measures to prevent complications.