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Multiple Sclerosis l: Introduction01:19

Multiple Sclerosis l: Introduction

Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...

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Sacral neuromodulation in patients with multiple sclerosis.

Daniele Minardi1, Giovanni Muzzonigro

  • 1Department of Clinic and Specialistic Sciences-Urology, Polytechnic University of the Marches Region-Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy. d.minardi@univpm.it

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Sacral neuromodulation (SNM) effectively treats voiding dysfunction in multiple sclerosis (MS) patients with urgency incontinence or detrusor-sphincter dyssynergia. It is not recommended for urinary retention due to detrusor underactivity.

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Area of Science:

  • Neurology
  • Urology

Background:

  • Multiple sclerosis (MS) frequently causes neurogenic lower urinary tract dysfunction.
  • Refractory symptoms significantly impact quality of life.

Purpose of the Study:

  • To evaluate sacral neuromodulation (SNM) for treating voiding dysfunction in MS patients.
  • To identify patient subgroups who benefit most from SNM.

Main Methods:

  • Retrospective chart review of 25 MS patients with refractory lower urinary tract symptoms.
  • Assessment of voiding frequency, incontinence episodes, residual urine, and quality of life during SNM testing.
  • Permanent InterStim implantation offered for >50% symptom improvement or functional gains.

Main Results:

  • 15 patients received permanent InterStim implants.
  • Significant improvements observed in urinary retention (decreased residual, increased voided volume) and incontinence episodes.
  • 66% of patients had a functioning device at a mean follow-up of 61.2 months.

Conclusions:

  • SNM is a viable medium- to long-term treatment for MS-related voiding dysfunction.
  • SNM is indicated for urgency incontinence and detrusor-sphincter dyssynergia in MS.
  • SNM is not suitable for urinary retention caused by detrusor underactivity.