Relationship of bladder dysfunction to lesion site in multiple sclerosis.

Area of Science:

• Neuro-urology
• Multiple Sclerosis Research
• Central Nervous System Disorders

Background:

• Voiding dysfunction is a common complication in multiple sclerosis (MS).
• Understanding the relationship between lesion location and bladder dysfunction is crucial for patient management.
• Previous studies have explored urinary symptoms in MS, but lesion site correlations require further investigation.

Purpose of the Study:

• To investigate the relationship between the type of voiding dysfunction and the specific lesion site in patients with multiple sclerosis.
• To determine if lesion location in the central nervous system influences bladder and urethral sphincter function.

Main Methods:

• 32 patients with multiple sclerosis underwent evaluation for voiding dysfunction using the International Prostate Symptom Score and urodynamic tests.
• Lesion sites were identified through a combination of neurological examination and magnetic resonance imaging (MRI).

Main Results:

• Urinary symptoms, particularly filling issues, correlated with disability status and disease duration, but not directly with lesion sites.
• Urodynamic findings included detrusor hyperreflexia (14 patients), hyporeflexia/areflexia (12 patients), and impaired contractile function (4 patients).
• Significant correlations were found between pontine lesions and detrusor hyporeflexia, and between cervical cord lesions and detrusor-sphincter dyssynergia.

Conclusions:

• Detrusor hyporeflexia is associated with pontine lesions, and detrusor-sphincter dyssynergia with cervical spinal cord lesions.
• The location of central nervous system lesions is a significant determinant of bladder and urethral sphincter dysfunction type in MS.
• A higher prevalence of emptying symptoms in Japanese patients may be linked to the observed rates of detrusor hyporeflexia and detrusor-sphincter dyssynergia.