Multiple sclerosis and the urologist

Scott E. Litwiller, Elliot Frohman, Philippe E Zimmern

Research output: Contribution to journalArticle

195 Citations (Scopus)

Abstract

Purpose: We provide an updated reference detailing the neurological and urological state of the art approach to multiple sclerosis (MS) with special emphasis on the pathology and physiology, effects on the genitourinary tract, diagnostic evaluation, and treatment of neurological and urological manifestations. Materials and Methods: A MEDLINE computerized reference search and manual bibliography review were performed to find pertinent peer reviewed articles on the neurological and urological manifestations and treatment of MS. A meta-analysis was performed on the urodynamic findings of 22 studies involving 1,882 patients from well-defined MS populations. Results: The majority of patients with MS have genitourinary symptoms ranging from urgency, urge incontinence and frequency to urinary retention. Symptoms do not accurately reflect the underlying urological pathology but parallel pyramidal tract dysfunction. Urodynamic evaluation has an important role in determining proper bladder management. The most common urodynamic finding is detrusor hyperreflexia in 62% of these patients, followed by detrusor- sphincter dyssynergia in 25% and hypocontractility in 20%. Less than 1% of patients has renal deterioration and most may be treated with conservative measures. If conservative measures fail, new forms of bladder reconstruction and diversion may be effectively used. The incidence of sexual dysfunction is up to 80% in men and 72% in women, and treatment focuses on improvement of overall disability and erectile or orgasmic function. Conclusions: Although the genitourinary consequences of MS are rarely life threatening, they can cause significant morbidity and patient frustration. With the rapid advances in the medical management of MS the urologist should be actively involved in multispecialty treatment of these patients.

Original languageEnglish (US)
Pages (from-to)743-757
Number of pages15
JournalJournal of Urology
Volume161
Issue number3
DOIs
StatePublished - Mar 1999

Fingerprint

Multiple Sclerosis
Urological Manifestations
Urodynamics
Neurologic Manifestations
Urinary Bladder
Pathology
Urge Urinary Incontinence
Abnormal Reflexes
Pyramidal Tracts
Frustration
Urinary Retention
Bibliography
Ataxia
Therapeutics
MEDLINE
Meta-Analysis
Urologists
Morbidity
Kidney
Incidence

Keywords

  • Bladder, neurogenic
  • Multiple sclerosis
  • Urodynamics

ASJC Scopus subject areas

  • Urology

Cite this

Multiple sclerosis and the urologist. / Litwiller, Scott E.; Frohman, Elliot; Zimmern, Philippe E.

In: Journal of Urology, Vol. 161, No. 3, 03.1999, p. 743-757.

Research output: Contribution to journalArticle

Litwiller, Scott E. ; Frohman, Elliot ; Zimmern, Philippe E. / Multiple sclerosis and the urologist. In: Journal of Urology. 1999 ; Vol. 161, No. 3. pp. 743-757.
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