Pharmacotherapeutic management of lower urinary tract symptoms in Multiple Sclerosis patients

ABSTRACT

Introduction

Multiple Sclerosis (MS) manifests with a plethora of signs and symptoms affecting brain structures and spinal pathways. The multitude of lesions in MS patients makes difficult to establish the relative role of each of them to lower urinary tract symptoms (LUTS). Generally, the subcortical white-matter lesions result in detrusor overactivity, whilst lesions of the spinal cord result in the combined occurrence of detrusor overactivity and detrusor-sphincter dyssynergia (DSD). It has been estimated that 80–90% of patients with MS will suffer from some form of LUTS over the course of the disease. Among LUTS, the most reported is detrusor overactivity which includes urinary urgency, frequent urination, nocturia, and urge urinary incontinence.

Areas covered

The authors review the management of lower urinary tract symptoms in MS patients providing their expert opinions on the subject matter.

Expert opinion

LUTS affect the quality of life substantially and are associated with a significantly increased mortality. The adequate management is an important challenge for both patients and caregivers with a multidisciplinary approach likely necessary.

KEYWORDS:

• Multiple sclerosis
• urinary dysfunction
• therapeutic management
• multidisciplinary approach

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Article Highlights

• It has been estimated that 80%−90% of patients with MS will suffer from some form of lower urinary tract symptoms (LUTS) over the course of the disease.

• The most common urodynamic abnormality in MS is now referred to as ‘neurogenic detrusor overactivity,’ also known as detrusor hyperreflexia.

• LUTS represent a major concern for patients with MS and pose a challenge to the treating physician for the impact on quality of life of patients.

• Accurate and timely diagnosis, prescription of medication (if appropriate), and implementation of coping strategies will significantly contribute to the well-being of people with MS.

• LUTS progressively worsen and the adequate management is an important challenge for both patients and caregiver.

• The management requires a multidisciplinary approach, focusing on patients' quality of life.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.