Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Management of neurogenic bladder in patients with multiple sclerosis

Nature Reviews Urology volume 13, pages 275–288 (2016)Cite this article

Subjects

Key Points

  • Lower urinary tract (LUT) symptoms are common in patients with multiple sclerosis; the exact symptoms vary in type and severity, and can evolve with progression of the disease

  • The management of LUT dysfunction in these patients requires a consensual approach, with cooperation between different medical professionals, and should take into consideration possible progression of the disease

  • Intermittent self-catheterization is essential for the management of patients with voiding symptoms, but might also have a role in management of those with storage symptoms

  • Intradetrusor botulinum toxin A injections are a highly effective and minimally invasive treatment of storage dysfunctions

  • Surgical options include augmentation cystoplasty, cutaneous continent diversion and ileal conduit surgery, and should be performed only after careful selection of patients

  • Multiple sclerosis has a progressive course and, therefore, patients with multiple sclerosis who also have LUT symptoms require regular long-term follow-up monitoring

Abstract

Lower urinary tract (LUT) dysfunction is common in patients with multiple sclerosis and is a major negative influence on the quality of life of these patients. The most commonly reported symptoms are those of the storage phase, of which detrusor overactivity is the most frequently reported urodynamic abnormality. The clinical evaluation of patients' LUT symptoms should include a bladder diary, uroflowmetry followed by measurement of post-void residual urine volume, urinalysis, ultrasonography, assessment of renal function, quality-of-life assessments and sometimes urodynamic investigations and/or cystoscopy. The management of these patients requires a multidisciplinary approach. Intermittent self-catheterization is the preferred option for management of incomplete bladder emptying and urinary retention. Antimuscarinics are the first-line treatment for patients with storage symptoms. If antimuscarinics are ineffective, or poorly tolerated, a range of other approaches, such as intradetrusor botulinum toxin A injections, tibial nerve stimulation and sacral neuromodulation are available, with varying levels of evidence in patients with multiple sclerosis. Surgical procedures should be performed only after careful selection of patients. Stress urinary incontinence owing to sphincter deficiency remains a therapeutic challenge, and is only managed surgically if conservative measures have failed. Multiple sclerosis has a progressive course, therefore, patients' LUT symptoms require regular, long-term follow-up monitoring.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Mechanisms of neuronal injury and degeneration in patients with multiple sclerosis.
Figure 2: Patterns of lower urinary tract dysfunction following neurological disease.
Figure 3: Algorithm for the management of storage symptoms in patients with multiple sclerosis.

Similar content being viewed by others

References

  1. Multiple Sclerosis International Federation. Atlas of MS 2013: mapping multiple sclerosis around the world. [online], (2013).

  2. Confavreux, C., Aimard, G. & Devic, M. Course and prognosis of multiple sclerosis assessed by the computerized data processing of 349 patients. Brain J. Neurol. 103, 281–300 (1980).

    Article  CAS  Google Scholar 

  3. Kutzelnigg, A. et al. Cortical demyelination and diffuse white matter injury in multiple sclerosis. Brain J. Neurol. 128, 2705–2712 (2005).

    Article  Google Scholar 

  4. Furby, J. et al. Magnetic resonance imaging measures of brain and spinal cord atrophy correlate with clinical impairment in secondary progressive multiple sclerosis. Mult. Scler. 14, 1068–1075 (2008).

    Article  CAS  PubMed  Google Scholar 

  5. Kurtzke, J. F. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33, 1444–1452 (1983).

    Article  CAS  PubMed  Google Scholar 

  6. Derfuss, T., Bergvall, N. K., Sfikas, N. & Tomic, D. L. Efficacy of fingolimod in patients with highly active relapsing-remitting multiple sclerosis. Curr. Med. Res. Opin. 31, 1687–1691 (2015).

    Article  CAS  PubMed  Google Scholar 

  7. Nortvedt, M. W. et al. Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis. Mult. Scler. 13, 106–112 (2007).

    Article  CAS  PubMed  Google Scholar 

  8. Betts, C. D., D'Mellow, M. T. & Fowler, C. J. Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 56, 245–250 (1993).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Fowler, C. J. et al. A UK consensus on the management of the bladder in multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 80, 470–477 (2009).

    CAS  PubMed  Google Scholar 

  10. Khan, F., Pallant, J. F., Shea, T. L. & Whishaw, M. Multiple sclerosis: prevalence and factors impacting bladder and bowel function in an Australian community cohort. Disabil. Rehabil. 31, 1567–1576 (2009).

    Article  PubMed  Google Scholar 

  11. Hemmett, L., Holmes, J., Barnes, M. & Russell, N. What drives quality of life in multiple sclerosis? QJM 97, 671–676 (2004).

    Article  CAS  PubMed  Google Scholar 

  12. Marrie, R. A., Cutter, G., Tyry, T., Vollmer, T. & Campagnolo, D. Disparities in the management of multiple sclerosis-related bladder symptoms. Neurology 68, 1971–1978 (2007).

    Article  CAS  PubMed  Google Scholar 

  13. Mayo, M. E. & Chetner, M. P. Lower urinary tract dysfunction in multiple sclerosis. Urology 39, 67–70 (1992).

    Article  CAS  PubMed  Google Scholar 

  14. Giannantoni, A. et al. Urological dysfunctions and upper urinary tract involvement in multiple sclerosis patients. Neurourol. Urodyn. 17, 89–98 (1998).

    Article  CAS  PubMed  Google Scholar 

  15. Koldewijn, E. L., Hommes, O. R., Lemmens, W. A. J. G., Debruyne, F. M. J. & Van Kerrebroeck, P. E. V. Relationship between lower urinary tract abnormalities and disease-related parameters in multiple sclerosis. J. Urol. 154, 169–173 (1995).

    Article  CAS  PubMed  Google Scholar 

  16. Gallien, P. et al. Vesicourethral dysfunction and urodynamic findings in multiple sclerosis: a study of 149 cases. Arch. Phys. Med. Rehabil. 79, 255–257 (1998).

    Article  CAS  PubMed  Google Scholar 

  17. Kasabian, N. G., Krause, I., Brown, W. E., Khan, Z. & Nagler, H. M. Fate of the upper urinary tract in multiple sclerosis. Neurourol. Urodyn. 14, 81–85 (1995).

    Article  CAS  PubMed  Google Scholar 

  18. Amarenco, G., Kerdraon, J. & Denys, P. Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases. Rev. Neurol. (Paris) 151, 722–730 (in French) (1995).

    CAS  Google Scholar 

  19. Murphy, A. M., Bethoux, F., Stough, D. & Goldman, H. B. Prevalence of stress urinary incontinence in women with multiple sclerosis. Int. Neurourol. J. 16, 86–90 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  20. de Seze, M. et al. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult. Scler. 13, 915–928 (2007).

    Article  PubMed  Google Scholar 

  21. Panicker, J. & Haslam, C. Lower urinary tract dysfunction in MS: management in the community. Br. J. Community Nurs. 14, 474–480 (2009).

    Article  PubMed  Google Scholar 

  22. Mahajan, S. T., Patel, P. B. & Marrie, R. A. Under treatment of overactive bladder symptoms in patients with multiple sclerosis: an ancillary analysis of the NARCOMS Patient Registry. J. Urol. 183, 1432–1437 (2010).

    Article  CAS  PubMed  Google Scholar 

  23. Araki, I., Matsui, M., Ozawa, K., Takeda, M. & Kuno, S. Relationship of bladder dysfunction to lesion site in multiple sclerosis. J. Urol. 169, 1384–1387 (2003).

    Article  PubMed  Google Scholar 

  24. Porru, D. et al. Urinary tract dysfunction in multiple sclerosis: is there a relation with disease-related parameters? Spinal Cord 35, 33–36 (1997).

    Article  CAS  PubMed  Google Scholar 

  25. Ciancio, S. J., Mutchnik, S. E., Rivera, V.M. & Boone, T. B. Urodynamic pattern changes in multiple sclerosis. Urology 57, 239–245 (2001).

    Article  CAS  PubMed  Google Scholar 

  26. Giannantoni, A. et al. Lower urinary tract dysfunction and disability status in patients with multiple sclerosis. Arch. Phys. Med. Rehabil. 80, 437–441 (1999).

    Article  CAS  PubMed  Google Scholar 

  27. De Ridder, D. et al. Bladder cancer in patients with multiple sclerosis treated with cyclophosphamide. J. Urol. 159, 1881–1884 (1998).

    Article  CAS  PubMed  Google Scholar 

  28. Desgrippes, A., Meria, P., Cortesse, A., Cochand-Priollet, B. & Cariou, G. Epidermoid carcinoma of the bladder [French]. Prog. Urol. 8, 321–329 (1998).

    CAS  PubMed  Google Scholar 

  29. Hennessey, A., Robertson, N. P., Swingler, R. & Compston, D. A. Urinary, faecal and sexual dysfunction in patients with multiple sclerosis. J. Neurol. 246, 1027–1032 (1999).

    Article  CAS  PubMed  Google Scholar 

  30. Perrigot, M., Richard, F., Veaux-Renault, V., Chatelain, C. & Küss, R. Bladder sphincter disorders in multiple sclerosis: symptomatology and evolution. 100 cases [French]. Sem. Hôp. 58, 2543–2546 (1982).

    CAS  PubMed  Google Scholar 

  31. Lawrenson, R., Wyndaele, J. J., Vlachonikolis, I., Farmer, C. & Glickman, S. Renal failure in patients with neurogenic lower urinary tract dysfunction. Neuroepidemiology 20, 138–143 (2001).

    Article  CAS  PubMed  Google Scholar 

  32. Castel-Lacanal, E. et al. Urinary complications and risk factors in symptomatic multiple sclerosis patients. Study of a cohort of 328 patients. Neurourol. Urodyn. 34, 32–36 (2015).

    Article  PubMed  Google Scholar 

  33. Abrams, P., Cardozo, L., Khoury, S. & Wein, A. (eds) Incontinence 5th edn (ICUD press, 2013).

    Google Scholar 

  34. Bonniaud, V. et al. Quality of life in multiple sclerosis patients with urinary disorders: discriminative validation of the English version of Qualiveen. Qual. Life Res. 14, 425–431 (2005).

    Article  PubMed  Google Scholar 

  35. Blok, B. et al. Guidelines on neuro-urology. European Association of Urology [online], (2015).

    Google Scholar 

  36. Fowlis, G. A., Waters, J. & Williams, G. The cost effectiveness of combined rapid tests (Multistix) in screening for urinary tract infections. J. R. Soc. Med. 87, 681–682 (1994).

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Khasriya, R. et al. The inadequacy of urinary dipstick and microscopy as surrogate markers of urinary tract infection in urological outpatients with lower urinary tract symptoms without acute frequency and dysuria. J. Urol. 183, 1843–1847 (2010).

    Article  PubMed  Google Scholar 

  38. Schwartz, D. S. & Barone, J. E. Correlation of urinalysis and dipstick results with catheter-associated urinary tract infections in surgical ICU patients. Intensive Care Med. 32, 1797–1801 (2006).

    Article  PubMed  Google Scholar 

  39. Mimoz, O., Bouchet, E., Edouard, A., Costa, Y. & Samii, K. Limited usefulness of urinary dipsticks to screen out catheter-associated bacteriuria in ICU patients. Anaesth. Intensive Care 23, 706–707 (1995).

    Article  CAS  PubMed  Google Scholar 

  40. Cetinel, B. et al. Management of lower urinary tract dysfunction in multiple sclerosis: a systematic review and Turkish consensus report. Neurourol. Urodyn. 32, 1047–1057 (2013).

    Article  PubMed  Google Scholar 

  41. Panicker, J. N., Fowler, C. J. & Kessler, T. M. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol. 14, 720–732 (2015).

    Article  PubMed  Google Scholar 

  42. The National Institute for Health and Care Excellence. Urinary incontinence in neurological disease: assessment and management. [online], (2012).

  43. Abrams, P. et al. 4th International Consultation on Incontinence. Recommendations of the international scientific committee. Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol. Urodyn. 29, 213–240 (2010).

    Article  CAS  PubMed  Google Scholar 

  44. Mingat, N. et al. Prospective study of methods of renal function evaluation in patients with neurogenic bladder dysfunction. Urology 82, 1032–1037 (2013).

    Article  PubMed  Google Scholar 

  45. Caramella, D. et al. Videourodynamics in patients with neurogenic bladder due to multiple sclerosis: our experience. Radiol. Med. 116, 432–443 (2011).

    Article  CAS  PubMed  Google Scholar 

  46. Bryant, C. M., Dowell, C. J. & Fairbrother, G. Caffeine reduction education to improve urinary symptoms. Br. J. Nurs. 11, 560–565 (2002).

    Article  PubMed  Google Scholar 

  47. Klarskov, P., Heely, E., Nyholdt, I., Rottensten, K. & Nordenbo, A. Biofeedback treatment of bladder dysfunction in multiple sclerosis. A randomized trial. Scand. J. Urol. Nephrol. Suppl. 157, 61–65 (1994).

    CAS  PubMed  Google Scholar 

  48. Vahtera, T., Haaranen, M., Viramo-Koskela, A. L. & Ruutiainen, J. Pelvic floor rehabilitation is effective in patients with multiple sclerosis. Clin. Rehabil. 11, 211–219 (1997).

    Article  CAS  PubMed  Google Scholar 

  49. McClurg, D., Ashe, R. G. & Lowe-Strong, A. S. Neuromuscular electrical stimulation and the treatment of lower urinary tract dysfunction in multiple sclerosis — a double blind, placebo controlled, randomised clinical trial. Neurourol. Urodyn. 27, 231–237 (2008).

    Article  CAS  PubMed  Google Scholar 

  50. McClurg, D., Ashe, R. G., Marshall, K. & Lowe-Strong, A. S. Comparison of pelvic floor muscle training, electromyography biofeedback, and neuromuscular electrical stimulation for bladder dysfunction in people with multiple sclerosis: a randomized pilot study. Neurourol. Urodyn. 25, 337–348 (2006).

    Article  CAS  PubMed  Google Scholar 

  51. Lucio, A., D'Ancona, C., Lopes, M., Perissinotto, M. & Damasceno, B. The effect of pelvic floor muscle training alone or in combination with electrostimulation in the treatment of sexual dysfunction in women with multiple sclerosis. Mult. Scler. 20, 1761–1768 (2014).

    Article  CAS  PubMed  Google Scholar 

  52. Deffieux, X. et al. Pelvic floor rehabilitation for female urinary incontinence: mechanisms of action [French]. Prog. Urol. 23, 491–501 (2013).

    Article  CAS  PubMed  Google Scholar 

  53. De Ridder, D., Vermeulen, C., Ketelaer, P., Van Poppel, H. & Baert, L. Pelvic floor rehabilitation in multiple sclerosis. Acta Neurol. Belg. 99, 61–64 (1999).

    CAS  PubMed  Google Scholar 

  54. de Sèze, M. & Gamé, X. Multiple sclerosis and pelviperineology: urinary and sexual dysfunctions and pregnancy [French]. Prog. Urol. 24, 483–494 (2014).

    Article  PubMed  Google Scholar 

  55. De Ridder, D. et al. Conservative bladder management in advanced multiple sclerosis. Mult. Scler. 11, 694–699 (2005).

    Article  CAS  PubMed  Google Scholar 

  56. Madhuvrata, P., Singh, M., Hasafa, Z. & Abdel-Fattah, M. Anticholinergic drugs for adult neurogenic detrusor overactivity: a systematic review and meta-analysis. Eur. Urol. 62, 816–830 (2012).

    Article  CAS  PubMed  Google Scholar 

  57. Fader, M. et al. Intravesical atropine compared to oral oxybutynin for neurogenic detrusor overactivity: a double-blind, randomized crossover trial. J. Urol. 177, 208–213 (2007).

    Article  CAS  PubMed  Google Scholar 

  58. van Rey, F. & Heesakkers, J. Solifenacin in multiple sclerosis patients with overactive bladder: a prospective study. Adv. Urol. 2011, 834753 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  59. Nicholas, R. S., Friede, T., Hollis, S. & Young, C. A. Anticholinergics for urinary symptoms in multiple sclerosis. Cochrane Database Syst. Rev. 1, CD004193 (2009).

    Google Scholar 

  60. Gajewski, J. B. & Awad, S. A. Oxybutynin versus propantheline in patients with multiple sclerosis and detrusor hyperreflexia. J. Urol. 135, 966–968 (1986).

    Article  CAS  PubMed  Google Scholar 

  61. Hebjorn, S. Treatment of detrusor hyperreflexia in multiple sclerosis: a double-blind, crossover clinical trial comparing methantheline bromide (Banthine), flavoxate chloride (Urispas) and meladrazine tartrate (Lisidonil). Urol. Int. 32, 209–217 (1977).

    Article  CAS  PubMed  Google Scholar 

  62. Ethans, K. D., Nance, P. W., Bard, R. J., Casey, A. R. & Schryvers, O. I. Efficacy and safety of tolterodine in people with neurogenic detrusor overactivity. J. Spinal Cord Med. 27, 214–218 (2004).

    Article  PubMed  Google Scholar 

  63. Amend, B. et al. Effective treatment of neurogenic detrusor dysfunction by combined high-dosed antimuscarinics without increased side-effects. Eur. Urol. 53, 1021–1028 (2008).

    Article  CAS  PubMed  Google Scholar 

  64. Valiquette, G., Herbert, J. & Maede-D'Alisera, P. Desmopressin in the management of nocturia in patients with multiple sclerosis. A double-blind, crossover trial. Arch. Neurol. 53, 1270–1275 (1996).

    Article  CAS  PubMed  Google Scholar 

  65. Eckford, S. B., Kohler-Ockmore, J. & Feneley, R. C. Long-term follow-up of transvaginal urethral closure and suprapubic cystostomy for urinary incontinence in women with multiple sclerosis. Br. J. Urol. 74, 319–321 (1994).

    Article  CAS  PubMed  Google Scholar 

  66. Kim, J.-H. in Primer on Multiple Sclerosis (ed. Giesser, B. S.) Ch. 15, 197–206 (Oxford Univ. Press, 2011).

    Google Scholar 

  67. Zahariou, A., Karamouti, M., Karagiannis, G. & Papaioannou, P. Maximal bladder capacity is a positive predictor of response to desmopressin treatment in patients with MS and nocturia. Int. Urol. Nephrol. 40, 65–69 (2008).

    Article  CAS  PubMed  Google Scholar 

  68. Tubridy, N., Addison, R. & Schon, F. Long term use of desmopressin for urinary symptoms in multiple sclerosis. Mult. Scler. 5, 416–417 (1999).

    CAS  PubMed  Google Scholar 

  69. Hoverd, P. A. & Fowler, C. J. Desmopressin in the treatment of daytime urinary frequency in patients with multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 65, 778–780 (1998).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Fredrikson, S. Nasal spray desmopressin treatment of bladder dysfunction in patients with multiple sclerosis. Acta Neurol. Scand. 94, 31–34 (1996).

    Article  CAS  PubMed  Google Scholar 

  71. Hilton, P., Hertogs, K. & Stanton, S. L. The use of desmopressin (DDAVP) for nocturia in women with multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 46, 854–855 (1983).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Bosma, R., Wynia, K., Havlíková, E., De Keyser, J. & Middel, B. Efficacy of desmopressin in patients with multiple sclerosis suffering from bladder dysfunction: a meta-analysis. Acta Neurol. Scand. 112, 1–5 (2005).

    Article  CAS  PubMed  Google Scholar 

  73. Hedlund, P. Cannabinoids and the endocannabinoid system in lower urinary tract function and dysfunction. Neurourol. Urodyn. 33, 46–53 (2014).

    Article  CAS  PubMed  Google Scholar 

  74. Freeman, R. M. et al. The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS). Int. Urogynecol. J. Pelvic Floor Dysfunct. 17, 636–641 (2006).

    Article  CAS  PubMed  Google Scholar 

  75. Brady, C. M. et al. An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Mult. Scler. 10, 425–433 (2004).

    Article  CAS  PubMed  Google Scholar 

  76. Kavia, R. B. C., De Ridder, D., Constantinescu, C. S., Stott, C. G. & Fowler, C. J. Randomized controlled trial of Sativex to treat detrusor overactivity in multiple sclerosis. Mult. Scler. 16, 1349–1359 (2010).

    Article  CAS  PubMed  Google Scholar 

  77. Schurch, B. et al. Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J. Urol. 174, 196–200 (2005).

    Article  CAS  PubMed  Google Scholar 

  78. Cruz, F. et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur. Urol. 60, 742–750 (2011).

    Article  CAS  PubMed  Google Scholar 

  79. Ginsberg, D. et al. Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J. Urol. 187, 2131–2139 (2012).

    Article  CAS  PubMed  Google Scholar 

  80. Ehren, I. et al. Efficacy and impact of botulinum toxin A on quality of life in patients with neurogenic detrusor overactivity. Scand. J. Urol. Nephrol. 41, 335–340 (2007).

    Article  CAS  PubMed  Google Scholar 

  81. Mangera, A. et al. Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA). Eur. Urol. 60, 784–795 (2011).

    Article  CAS  PubMed  Google Scholar 

  82. Apostolidis, A., Dasgupta, P. & Fowler, C. J. Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity. Eur. Urol. 49, 644–650 (2006).

    Article  CAS  PubMed  Google Scholar 

  83. Kalsi, V. et al. Botulinum injections for the treatment of bladder symptoms of multiple sclerosis. Ann. Neurol. 62, 452–457 (2007).

    Article  CAS  PubMed  Google Scholar 

  84. Mehnert, U., Birzele, J., Reuter, K. & Schurch, B. The effect of botulinum toxin type a on overactive bladder symptoms in patients with multiple sclerosis: a pilot study. J. Urol. 184, 1011–1016 (2010).

    Article  CAS  PubMed  Google Scholar 

  85. Karsenty, G. et al. A novel technique to achieve cutaneous continent urinary diversion in spinal cord-injured patients unable to catheterize through native urethra. Spinal Cord 46, 305–310 (2007).

    Article  PubMed  Google Scholar 

  86. Gamé, X. et al. Botulinum toxin A detrusor injections in patients with neurogenic detrusor overactivity significantly decrease the incidence of symptomatic urinary tract infections. Eur. Urol. 53, 613–618 (2008).

    Article  PubMed  Google Scholar 

  87. Lekka, E. & Lee, L. K. Successful treatment with intradetrusor botulinum-A toxin for urethral urinary leakage (catheter bypassing) in patients with end-staged multiple sclerosis and indwelling suprapubic catheters. Eur. Urol. 50, 806–810 (2006).

    Article  PubMed  Google Scholar 

  88. Stoller, M. Afferent nerve stimulation for pelvic floor dysfunction. Eur. Urol. 35 (Suppl. 2), 16 (1999).

    Google Scholar 

  89. Kabay, S. C., Kabay, S., Yucel, M. & Ozden, H. Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's disease. Neurourol. Urodyn. 28, 62–67 (2009).

    Article  PubMed  Google Scholar 

  90. Kabay, S. C., Yucel, M. & Kabay, S. Acute effect of posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with multiple sclerosis: urodynamic study. Urology 71, 641–645 (2008).

    Article  PubMed  Google Scholar 

  91. Gobbi, C. et al. Percutaneous posterior tibial nerve stimulation as an effective treatment of refractory lower urinary tract symptoms in patients with multiple sclerosis: preliminary data from a multicentre, prospective, open label trial. Mult. Scler. 17, 1514–1519 (2011).

    Article  CAS  PubMed  Google Scholar 

  92. Andrews, B. J. & Reynard, J. M. Transcutaneous posterior tibial nerve stimulation for treatment of detrusor hyperreflexia in spinal cord injury. J. Urol. 170, 926 (2003).

    Article  CAS  PubMed  Google Scholar 

  93. Govier, F. E., Litwiller, S., Nitti, V., Kreder, K. J. Jr & Rosenblatt, P. Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J. Urol. 165, 1193–1198 (2001).

    Article  CAS  PubMed  Google Scholar 

  94. van Balken, M. R., Vergunst, H. & Bemelmans, B. L. H. Prognostic factors for successful percutaneous tibial nerve stimulation. Eur. Urol. 49, 360–365 (2006).

    Article  CAS  PubMed  Google Scholar 

  95. Kabay, S. et al. The clinical and urodynamic results of a 3-month percutaneous posterior tibial nerve stimulation treatment in patients with multiple sclerosis-related neurogenic bladder dysfunction. Neurourol. Urodyn. 28, 964–968 (2009).

    Article  PubMed  Google Scholar 

  96. de Seze, M. et al. Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study. Neurourol. Urodyn. 30, 306–311 (2011).

    Article  PubMed  Google Scholar 

  97. Chartier-Kastler, E. J. et al. Long-term results of sacral nerve stimulation (S3) for the treatment of neurogenic refractory urge incontinence related to detrusor hyperreflexia. J. Urol. 164, 1476–1480 (2000).

    Article  CAS  PubMed  Google Scholar 

  98. Craggs, M. & McFarlane, J. Neuromodulation of the lower urinary tract. Exp. Physiol. 84, 149–160 (1999).

    Article  CAS  PubMed  Google Scholar 

  99. Kessler, T. M. et al. Sacral neuromodulation for neurogenic lower urinary tract dysfunction: systematic review and meta-analysis. Eur. Urol. 58, 865–874 (2010).

    Article  PubMed  Google Scholar 

  100. Wallace, P. A., Lane, F. L. & Noblett, K. L. Sacral nerve neuromodulation in patients with underlying neurologic disease. Am. J. Obstet. Gynecol. 197, 96.e1–96.e5 (2007).

    Article  Google Scholar 

  101. Chaabane, W. et al. Sacral neuromodulation for treating neurogenic bladder dysfunction: clinical and urodynamic study. Neurourol. Urodyn. 30, 547–550 (2011).

    Article  PubMed  Google Scholar 

  102. Minardi, D. & Muzzonigro, G. Sacral neuromodulation in patients with multiple sclerosis. World J. Urol. 30, 123–128 (2011).

    Article  PubMed  Google Scholar 

  103. Peters, K. M., Kandagatla, P., Killinger, K. A., Wolfert, C. & Boura, J. A. Clinical outcomes of sacral neuromodulation in patients with neurologic conditions. Urology 81, 738–743 (2013).

    Article  PubMed  Google Scholar 

  104. Minardi, D. & Muzzonigro, G. Lower urinary tract and bowel disorders and multiple sclerosis: role of sacral neuromodulation: a preliminary report. Neuromodulation 8, 176–181 (2005).

    Article  PubMed  Google Scholar 

  105. Marinkovic, S. P. & Gillen, L. M. Sacral neuromodulation for multiple sclerosis patients with urinary retention and clean intermittent catheterization. Int. Urogynecol J. 21, 223–228 (2010).

    Article  PubMed  Google Scholar 

  106. Andretta, E., Simeone, C., Ostardo, E., Pastorello, M. & Zuliani, C. Usefulness of sacral nerve modulation in a series of multiple sclerosis patients with bladder dysfunction. J. Neurol. Sci. 347, 257–261 (2014).

    Article  PubMed  Google Scholar 

  107. Zachoval, R. et al. Augmentation cystoplasty in patients with multiple sclerosis. Urol. Int. 70, 21–26 (2003).

    Article  PubMed  Google Scholar 

  108. Venn, S. N. & Mundy, A. R. Long-term results of augmentation cystoplasty. Eur. Urol. 34, 40–42 (1998).

    Article  PubMed  Google Scholar 

  109. Herschorn, S. Long-term outcome of augmentation enterocystoplasty for neurogenic bladder. J. Urol. 187, e668 (2012).

    Article  Google Scholar 

  110. Gould, J. J. & Stoffel, J. T. Robotic enterocystoplasty: technique and early outcomes. J. Endourol. 25, 91–95 (2011).

    Article  PubMed  Google Scholar 

  111. Liard, A., Séguier-Lipszyc, E., Mathiot, A. & Mitrofanoff, P. The Mitrofanoff procedure: 20 years later. J. Urol. 165, 2394–2398 (2001).

    Article  CAS  PubMed  Google Scholar 

  112. Moreno, J. G. et al. Improved quality of life and sexuality with continent urinary diversion in quadriplegic women with umbilical stoma. Arch. Phys. Med. Rehabil. 76, 758–762 (1995).

    Article  CAS  PubMed  Google Scholar 

  113. Stein, R. et al. Urinary diversion and orthotopic bladder substitution in children and young adults with neurogenic bladder: a safe option for treatment? J. Urol. 163, 568–573 (2000).

    Article  CAS  PubMed  Google Scholar 

  114. Vian, E., Soustelle, L., Viale, S. & Costa, P. A technique of continent vesicostomy with ileocystoplasty: study of 32 patients. Prog. Urol. 19, 116–121 (2009).

    Article  CAS  PubMed  Google Scholar 

  115. Jacques, C., David, G. & Gilles, K. (eds) Textbook of the Neurogenic Bladder 3rd edn (CRC Press, 2011).

    Google Scholar 

  116. Legrand, G. et al. Functional outcomes after management of end-stage neurological bladder dysfunction with ileal conduit in a multiple sclerosis population: a monocentric experience. Urology 78, 937–941 (2011).

    Article  PubMed  Google Scholar 

  117. Guillotreau, J. et al. Prospective evaluation of laparoscopic assisted cystectomy and ileal conduit in advanced multiple sclerosis. Urology 80, 852–857 (2012).

    Article  PubMed  Google Scholar 

  118. Lapides, J., Diokno, A. C., Silber, S. J. & Lowe, B. S. Clean, intermittent self-catheterization in the treatment of urinary tract disease. Trans. Am. Assoc. Genitourin. Surg. 63, 92–96 (1971).

    CAS  PubMed  Google Scholar 

  119. Kirchhof, K. & Fowler, C. J. The value of the Kurtzke Functional Systems Scales in predicting incomplete bladder emptying. Spinal Cord 38, 409–413 (2000).

    Article  CAS  PubMed  Google Scholar 

  120. Vahter, L. et al. Clean intermittent self-catheterization in persons with multiple sclerosis: the influence of cognitive dysfunction. Mult. Scler. 15, 379–384 (2009).

    Article  CAS  PubMed  Google Scholar 

  121. Seth, J. H., Haslam, C. & Panicker, J. N. Ensuring patient adherence to clean intermittent self-catheterization. Patient Prefer. Adherence 8, 191–198 (2014).

    PubMed  PubMed Central  Google Scholar 

  122. Sand, P. K. & Sand, R. I. The diagnosis and management of lower urinary tract symptoms in multiple sclerosis patients. Dis. Mon. 59, 261–268 (2013).

    Article  PubMed  Google Scholar 

  123. Yonnet, G. J., Fjeldstad, A. S., Carlson, N. G. & Rose, J. W. Advances in the management of neurogenic detrusor overactivity in multiple sclerosis. Int. J. MS Care 15, 66–72 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  124. Schulte-Baukloh, H. et al. Efficacy of botulinum-A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: an objective and subjective analysis. Neurourol. Urodyn. 25, 110–115 (2006).

    Article  CAS  PubMed  Google Scholar 

  125. Castel-Lacanal, E. et al. Impact of intermittent catheterization on the quality of life of multiple sclerosis patients. World J. Urol. 31, 1445–1450 (2013).

    Article  CAS  PubMed  Google Scholar 

  126. O'Riordan, J. I. et al. Do alpha-blockers have a role in lower urinary tract dysfunction in multiple sclerosis? J. Urol. 153, 1114–1116 (1995).

    Article  CAS  PubMed  Google Scholar 

  127. Weld, K. J. & Dmochowski, R. R. Effect of bladder management on urological complications in spinal cord injured patients. J. Urol. 163, 768–772 (2000).

    Article  CAS  PubMed  Google Scholar 

  128. Bennett, C. J., Young, M. N., Adkins, R. H. & Diaz, F. Comparison of bladder management complication outcomes in female spinal cord injury patients. J. Urol. 153, 1458–1460 (1995).

    Article  CAS  PubMed  Google Scholar 

  129. Larsen, L. D., Chamberlin, D. A., Khonsari, F. & Ahlering, T. E. Retrospective analysis of urologic complications in male patients with spinal cord injury managed with and without indwelling urinary catheters. Urology 50, 418–422 (1997).

    Article  CAS  PubMed  Google Scholar 

  130. Mitsui, T., Minami, K., Furuno, T., Morita, H. & Koyanagi, T. Is suprapubic cystostomy an optimal urinary management in high quadriplegics? A comparative study of suprapubic cystostomy and clean intermittent catheterization. Eur. Urol. 38, 434–438 (2000).

    Article  CAS  PubMed  Google Scholar 

  131. West, D. A. et al. Role of chronic catheterization in the development of bladder cancer in patients with spinal cord injury. Urology 53, 292–297 (1999).

    Article  CAS  PubMed  Google Scholar 

  132. James, R., Frasure, H. E. & Mahajan, S. T. Urinary catheterization may not adversely impact quality of life in multiple sclerosis patients. ISRN Neurol. 2014, 167030 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  133. Chancellor, M. B. et al. Sphincteric stent versus external sphincterotomy in spinal cord injured men: prospective randomized multicenter trial. J. Urol. 161, 1893–1898 (1999).

    Article  CAS  PubMed  Google Scholar 

  134. Fontaine, E. et al. Reappraisal of endoscopic sphincterotomy for post-traumatic neurogenic bladder: a prospective study. J. Urol. 155, 277–280 (1996).

    Article  CAS  PubMed  Google Scholar 

  135. Gallien, P. et al. Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients. J. Neurol. Neurosurg. Psychiatry 76, 1670–1676 (2005).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  136. de Sèze, M. et al. Botulinum A toxin and detrusor sphincter dyssynergia: a double-blind lidocaine-controlled study in 13 patients with spinal cord disease. Eur. Urol. 42, 56–62 (2002).

    Article  PubMed  Google Scholar 

  137. Phelan, M. W. et al. Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. J. Urol. 165, 1107–1110 (2001).

    Article  CAS  PubMed  Google Scholar 

  138. Utomo, E., Groen, J. & Blok, B. F. Surgical management of functional bladder outlet obstruction in adults with neurogenic bladder dysfunction. Cochrane Database Syst. Rev. 5, CD004927 (2014).

    Google Scholar 

Download references

Acknowledgements

V.P. acknowledges support from the European Urological Scholarship Programme

Author information

Authors and Affiliations

  1. Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance-Publique-Hôpitaux, 47–83 boulevard de l'hôpital, Paris Cedex 13, 75651, France

    Véronique Phé & Emmanuel Chartier–Kastler

  2. Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, 33 Queen Square, London, WC1N 3BG, UK

    Véronique Phé & Jalesh N. Panicker

Authors
  1. Véronique Phé
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emmanuel Chartier–Kastler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jalesh N. Panicker
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors researched data for this article, and made a significant contribution to discussions of content. V.P. wrote the manuscript, and all authors reviewed and/or edited the manuscript prior to submission.

Corresponding author

Correspondence to Véronique Phé.

Ethics declarations

Competing interests

E.C.K. has acted as a consultant of Allergan, Astellas, Axonics, Coloplast, Medtronic and and, and has received honoraria from Allergan, Astellas, Coloplast, Medtronic and Pfizer. V.P. and J.P. declare no competing interests.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Phé, V., Chartier–Kastler, E. & Panicker, J. Management of neurogenic bladder in patients with multiple sclerosis. Nat Rev Urol 13, 275–288 (2016). https://doi.org/10.1038/nrurol.2016.53

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrurol.2016.53

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing