Lower Urinary Tract Dysfunction in Pediatric Patients with Multiple Sclerosis: Diagnostic and Management Concerns
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Published on: August 14, 2019
Maria Laura Sollini1,2, Chiara Pellegrino1, Giulia Barone1,3
1Division of Neuro-Urology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Insights
Pediatric multiple sclerosis (MS) can present with urinary symptoms like incontinence or retention. Early urological care and multidisciplinary teams are crucial for managing these manifestations in children with MS.
Area of Science:
- Neurology
- Urology
- Pediatrics
Background:
- Multiple sclerosis (MS) incidence is rising in children.
- Pediatric MS symptoms are diverse and can mimic acute neurological events.
- Urological manifestations in pediatric MS are understudied.
Purpose of the Study:
- To describe the urological manifestations in children diagnosed with multiple sclerosis.
- To share clinical experience regarding MS-related urological symptoms in pediatric patients.
Main Methods:
- Retrospective evaluation of pediatric patients with MS (Krupp criteria) and urological symptoms.
- Data collection included demographics, clinical history, MRI findings, and urological assessments.
- Analysis of urinary symptoms, urodynamic patterns, and treatment strategies.
Main Results:
- Six pediatric MS cases with urological symptoms were identified.
- Urinary incontinence (5 patients) and urinary retention (1 patient) were reported.
- Urodynamics revealed overactive and underactive bladder patterns; treatments included catheterization, medications, and botulinum toxin.
- Low acceptance of invasive urological evaluations was noted.
Conclusions:
- MS diagnosis can be a significant emotional burden for pediatric patients.
- Integrating pediatric urologists into multidisciplinary teams is recommended for timely management of urological issues in pediatric MS.
- Prompt urological care from diagnosis is essential for affected children.
Background:
Multiple sclerosis (MS) is increasing in the pediatric population and, as in adults, symptoms vary among patients. In children the first manifestations can sometimes overlap with acute neurological symptoms. Urological symptoms have not been much studied in childhood. We shared our experience with MS urological manifestation in children.
Methods:
This article is a retrospective evaluation of all children with MS, according to the Krupp criteria, who also present with urological symptoms. We collected demographic and clinical history, the MR localization of demyelinating lesions, urological symptoms, and exams.
Results:
We report on six MS pediatric cases with urological manifestation. Urinary symptoms, characterized by urinary incontinence in five patients and urinary retention in one patient, appeared in a different time frame from MS diagnosis. Urodynamic exams showed both overactive and underactive bladder patterns. Treatment was defined according to lower urinary tract dysfunction, using clean intermittent catheterization, oxybutynin, and intradetrusor Onabotulinum Toxin-A injection. A low acceptance rate of invasive evaluation and urological management was observed.
Conclusions:
The MS diagnosis was traumatic for all our patients. We believe it is important to address urological care in young people from the time of diagnosis for prompt management; it could be useful to include a pediatric urologist in multidisciplinary teams.
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