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Urodynamics assessment in patients with multiple sclerosis.

Nicholas Faure Walker1,2, Alexandra Bacon3,4, Manisha Teji2

  • 1Epsom and St Helier University Hospitals NHS Trust Epsom UK.

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|May 1, 2026
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Summary

Urodynamics (UDS) are often performed early in multiple sclerosis (MS) care, potentially delaying treatment. Video UDS is recommended for men with MS, while standard UDS is sufficient for women with MS and overactive bladder symptoms.

Keywords:
detrusor overactivitymultiple sclerosisneurogenic bladderoveractive bladderurodynamics

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Area of Science:

  • Urology
  • Neurology
  • Medical Diagnostics

Background:

  • Lower urinary tract symptoms are common in multiple sclerosis (MS).
  • Urodynamics (UDS) assesses bladder function but its timing in MS patient pathways is debated.
  • Video UDS versus standard UDS efficacy for MS patients requires evaluation.

Purpose of the Study:

  • To review initial urodynamics (UDS) findings in patients with multiple sclerosis (MS).
  • To establish the role of UDS within the treatment pathway for MS-related lower urinary tract symptoms.
  • To evaluate the benefit of video UDS compared to standard UDS.

Main Methods:

  • Retrospective analysis of prospectively maintained databases from UK hospitals.
  • Inclusion criteria: Onabotulinumtoxin A (BTX-A) naïve, MS patients who had undergone UDS.
  • Data collected on UDS findings, subsequent management changes, and treatment outcomes.

Main Results:

  • 157 MS patients (UK departments) were analyzed.
  • Abnormalities like high end-fill pressures and vesico-ureteric reflux were noted in a subset of patients.
  • Following UDS, 85.4% of patients had management changes, including medication, self-catheterisation, BTX-A injections, or surgery.

Conclusions:

  • Urodynamics (UDS) is frequently performed before conservative/medical management in MS patients, potentially delaying non-invasive treatments.
  • Video UDS is recommended for initial assessment in men with MS.
  • Standard UDS is adequate for women with MS experiencing pure overactive bladder symptoms unresponsive to initial treatments, unless renal function or anatomy is compromised.