Management of bladder dysfunction in multiple sclerosis

Sixty-seven consecutive patients participated in a prospective urodynamic study of the diagnosis and treatment of urinary bladder symptoms in multiple sclerosis. The etiology of symptoms was classified as either failure to store urine (30%), failure to empty the bladder (18%), or a combination of the two (50%). Treatment was individualized on the basis of the underlying pathophysiology and consisted of intermittent self-catheterization (21%), none (20%), surgical (12%), drugs (9%), voiding maneuvers (6%), and external condom drainage (6%). In 18 patients (27%), lesser forms of treatment were unsuccessful, and indwelling vesical catheters were required. Symptoms correlated poorly with urodynamic findings, and treatment based on symptoms alone would have been ineffective in over half the patients.