Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis

Area of Science:

• Neurology
• Urology

Background:

• Multiple sclerosis (MS) frequently causes bladder dysfunction.
• Urinary symptoms in MS patients can significantly impact quality of life.

Purpose of the Study:

• To investigate the relationship between neurological features and bladder dysfunction in multiple sclerosis patients.
• To identify reliable indicators of bladder dysfunction and upper tract disease in MS.

Main Methods:

• Evaluation of 170 patients with multiple sclerosis and bladder dysfunction.
• Correlation analysis between neurological signs (especially pyramidal impairment) and urinary symptoms.
• Cystometry to assess bladder function (detrusor hyperreflexia, areflexia).
• Measurement of post-micturition residual urine volume.

Main Results:

• Urinary symptom severity correlated with the degree of pyramidal impairment in lower limbs, suggesting spinal involvement.
• Detrusor hyperreflexia was the most common cystometric finding; no areflexia was observed.
• Over half of patients had elevated post-micturition residual volumes, but symptoms were unreliable predictors of poor bladder emptying.
• Upper tract disease was rare, observed in only two patients with severe, long-standing MS requiring indwelling catheters.

Conclusions:

• Bladder dysfunction in MS is often associated with spinal cord lesions, indicated by pyramidal impairment.
• Detrusor hyperreflexia is expected in MS patients with irritative urinary symptoms and lower limb pyramidal signs.
• Measuring residual urine volume is crucial for guiding appropriate treatment, as symptoms alone are unreliable indicators of bladder emptying.