Neurourodynamic evaluation of voiding dysfunction in multiple sclerosis

During a period of 2 1/2 years, 198 patients with definite MS were admitted to our neurological department. 88 were investigated neurourodynamically because of distinct voiding dysfunction. 73 patients showed detrusor hyperreflexia, 14 detrusor hyporeflexia or areflexia and one had normal findings. There was no obvious correlation between the occurrence of the symptoms, irritative and obstructive, and the allocation of the patients into different cystometric groups. The predominant symptom was urge incontinence. More men had been treated or were permanently treated with intravesical catheter, but mean residual urine did not show any sex difference. In 36 patients with detrusor hyperreflexia, dyssynergia was observed and was classified into 3 groups. In the group with clonic sphincter EMG activity during voiding, 5 of the patients had dyssynergia because of flexor spasms transmitted to the sphincter. In patients with dyssynergia characterized by increased sphincter activity throughout detrusor contraction, a large mean residual urine was noted, but dyssynergia did not always prevent acceptable emptying. A low rate of complication in the upper urinary tract was observed. Treatment is discussed.