Lower urinary tract dysfunction in MS: management in the community.

Area of Science:

• Neurology
• Urology

Background:

• Lower urinary tract dysfunction (LUTD) is a frequent complication of multiple sclerosis (MS).
• LUTD in MS can manifest as bladder storage or voiding dysfunction.
• Despite its prevalence, LUTD in MS is generally considered medically manageable with a low risk of progression to renal failure.

Purpose of the Study:

• To outline the evaluation and management strategies for lower urinary tract dysfunction in multiple sclerosis patients.
• To emphasize the treatability and medical manageability of LUTD in the context of MS.

Main Methods:

• Initial evaluation involves comprehensive patient history and bladder diary use.
• Ultrasonography is employed to assess post-void residual urine volume and upper urinary tract status.
• Management strategies are tailored based on the type of dysfunction (storage vs. voiding).

Main Results:

• Incomplete bladder emptying, particularly with post-void residual urine exceeding 100 ml, is often managed with clean intermittent self-catheterization.
• Bladder storage symptoms are typically addressed with antimuscarinic medications.
• Alternative treatments include desmopressin and botulinum toxin type A injections for refractory cases.

Conclusions:

• Lower urinary tract dysfunction in multiple sclerosis is common but effectively managed through targeted treatments.
• Early evaluation and appropriate interventions can prevent complications and maintain quality of life.
• Referral to specialist urology services is indicated in specific complex cases.