Historical and Current Concepts Regarding Urodynamics in Multiple Sclerosis Patients

  • Jennifer RothschildEmail author
  • Chris Weichen Xu
Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Reconstructed Bladder Function & Dysfunction


Purpose of Review

In this review, current literature on management of neurogenic bladder in patients with multiple sclerosis (MS) is summarized. Topics include a review of MS, a brief overview of general treatment options, the effects of MS may manifest on lower urinary tract symptoms (LUTS), and clinical assessment of these patients. The utility of urodynamic evaluation in this patient population and the use of antibiotic prophylaxis in patients with MS on immunomodulatory medications are reviewed.

Recent Findings

Unlike neurogenic bladder in spinal cord patients, lower urinary tract dysfunction in MS patients rarely leads to upper urinary tract deterioration. Currently there is no consensus on imaging as a screening tool to assess renal deterioration in this patient population. Internationally, there are differing opinions on the necessity of performing invasive urodynamic (UDS) investigation in MS patients during initial assessment. However, UDS evaluation can be useful in the guidance of treatment options and patient counseling and prior to more invasive interventions.


Depending on the severity of MS, lower urinary tract symptoms are common and can evolve with progression of the disease. Although individual guidelines exist for management of patients with MS and select aspects of neurogenic LUTS, an optimal guideline for initial evaluation and surveillance is not available. The evaluation of patients with MS reporting LUTS should be uniquely tailored and take into consideration individual symptoms, disease course, comorbidities, and medications. Additionally, MS patients on immunomodulation medications that undergo UDS should be considered for prophylactic antibiotics.


Lower urinary tract symptoms Neurogenic bladder Urinary retention Overactive bladder Urinary incontinence Multiple sclerosis Urodynamic evaluation 


Compliance with Ethical Standards

Conflict of Interest

The author declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Alonso A, Hernán MA. Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology. 2008;71:129–35.CrossRefGoogle Scholar
  2. 2.
    Goodin DS. The epidemiology of multiple sclerosis: insights to disease pathogenesis. Handb Clin Neurol Elsevier. 2014;122:231–66.CrossRefGoogle Scholar
  3. 3.
    Weiner HL. Multiple sclerosis is an inflammatory T-cell-mediated autoimmune disease. Arch Neurol. 2004;61:1613–5.CrossRefGoogle Scholar
  4. 4.
    Hafler DA, Compston A, Sawcer S, Lander ES, Daly MJ, De Jager PL, et al. Risk alleles for multiple sclerosis identified by a genomewide study. N Engl J Med. 2007;357:851–62.CrossRefGoogle Scholar
  5. 5.
    Owens GP, Gilden D, Burgoon MP, Yu X, Bennett JL. Viruses and multiple sclerosis. Neuroscientist. 2011;17:659–76.CrossRefGoogle Scholar
  6. 6.
    Kantarci OH, Weinshenker BG. Natural history of multiple sclerosis. Neurol Clin. 2005;23:17–38.CrossRefGoogle Scholar
  7. 7.
    Goldenberg MM. Multiple sclerosis review. Pharm Ther. 2012;37.Google Scholar
  8. 8.
    Howard J, Trevick S, Younger DS. Epidemiology of multiple sclerosis. Neurol Clin. 2016;34:919–39.CrossRefGoogle Scholar
  9. 9.
    Calabresi P. Diagnosis and management of multiple sclerosis. Am Fam Physician. 2004.Google Scholar
  10. 10.
    Ontaneda D, Thompson AJ, Fox RJ, Cohen JA. Progressive multiple sclerosis: prospects for disease therapy, repair, and restoration of function. Lancet. 2017;389:1357–66.CrossRefGoogle Scholar
  11. 11.
    Dillon BE, Lemack GE. Urodynamics in the evaluation of the patient with multiple sclerosis: when are they helpful and how do we use them? Urol Clin North Am. 2014;41:439–44–ix.CrossRefGoogle Scholar
  12. 12.
    Giannantoni A, Scivoletto G, Di Stasi SM, Grasso MG, Finazzi Agrò E, Collura G, et al. Lower urinary tract dysfunction and disability status in patients with multiple sclerosis. Arch Phys Med Rehabil. 1999;80:437–41.CrossRefGoogle Scholar
  13. 13.
    Aktas O, Wattjes MP, Stangel M, Hartung HP. Diagnosis of multiple sclerosis: revision of the McDonald criteria 2017. Nervenarzt. 2018;89:1344–54.CrossRefGoogle Scholar
  14. 14.
    Lublin FD. The incomplete nature of multiple sclerosis relapse resolution. J Neurol Sci. 2007;256(Suppl 1):S14–8.CrossRefGoogle Scholar
  15. 15.
    Burton JM, O'Connor PW, Hohol M, Beyene J. Oral versus intravenous steroids for treatment of relapses in multiple sclerosis. Burton JM, editor. Cochrane Database Syst Rev. Chichester, UK: John Wiley & Sons, Ltd; 2009;56:CD006921.Google Scholar
  16. 16.
    Thrower BW. Relapse management in multiple sclerosis. Neurologist. 2009;15:1–5.CrossRefGoogle Scholar
  17. 17.
    Ross AP. Management of multiple sclerosis. Int J MS Care. 2014.Google Scholar
  18. 18•.
    Rae-Grant A, Day GS, Marrie RA, Rabinstein A, Cree BAC, Gronseth GS, et al. Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis: report of the guideline development, dissemination, and implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90:777–88. Guidelines for the therapeutic management of multiple sclerosis from the American Academy of Neurology. Google Scholar
  19. 19.
    Capra R, Cordioli C, Rasia S, Gallo F, Signori A, Sormani MP. Assessing long-term prognosis improvement as a consequence of treatment pattern changes in MS. Mult Scler. 2017;23:1757–61.CrossRefGoogle Scholar
  20. 20.
    Lizak N, Lugaresi A, Alroughani R, Lechner-Scott J, Slee M, Havrdova E, et al. Highly active immunomodulatory therapy ameliorates accumulation of disability in moderately advanced and advanced multiple sclerosis. J Neurol Neurosurg Psychiatry. 2017;88:196–203.CrossRefGoogle Scholar
  21. 21.
    Brown JWL, Coles A, Horakova D, Havrdova E, Izquierdo G, Prat A, et al. Association of initial disease-modifying therapy with later conversion to secondary progressive multiple sclerosis. JAMA. 2019;321:175–87.CrossRefGoogle Scholar
  22. 22•.
    Montalban X, Gold R, Thompson AJ, Otero-Romero S, Amato MP, Chandraratna D, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler. 2018;24:96–120. Joint recommendations from the European Committee for Treatment and Research in Multiple Sclerosis and the European Academy of Neurology for the treatment of people with multiple sclerosis.Google Scholar
  23. 23.
    Filippini G, Del Giovane C, Vacchi L, D'Amico R, Di Pietrantonj C, Beecher D, et al. Immunomodulators and immunosuppressants for multiple sclerosis: a network meta-analysis. Cochrane multiple sclerosis and rare diseases of the CNS Group, editor. Cochrane Database Syst Rev 2013;50:CD008933.Google Scholar
  24. 24.
    Nortvedt MW, Riise T, Frugård J, Mohn J, Bakke A, Skår AB, et al. Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis. Mult Scler. 2007;13:106–12.CrossRefGoogle Scholar
  25. 25.
    Phadke JG. Clinical aspects of multiple sclerosis in north-East Scotland with particular reference to its course and prognosis. Brain. 1990;113(Pt 6):1597–628.CrossRefGoogle Scholar
  26. 26.
    Koldewijn EL, Hommes OR, Lemmens WA, Debruyne FM, van Kerrebroeck PE. Relationship between lower urinary tract abnormalities and disease-related parameters in multiple sclerosis. JURO. 1995;154:169–73.Google Scholar
  27. 27•.
    Phé V, Kastler EC, Panicker JN. Management of neurogenic bladder in patients with multiple sclerosis. Nature Publishing Group Nature Publishing Group. 2016;13:275–88. Summary of the management of neurogenic bladder in patients with multiple sclerosis. Google Scholar
  28. 28•.
    Aharony SM, Lam O, Corcos J. Evaluation of lower urinary tract symptoms in multiple sclerosis patients: Review of the literature and current guidelines. Can Urol Assoc J. 2017;11:61–4. Review of literature and current guidelines for the evaluation of lower urinary tract symptoms in patients with multiple sclerosis. Google Scholar
  29. 29.
    Blaivas JG, Barbalias GA. Detrusor-external sphincter dyssynergia in men with multiple sclerosis: an ominous urologic condition. JURO. 1984;131:91–4.Google Scholar
  30. 30.
    Stoffel JT. Contemporary management of the neurogenic bladder for mutliple sclerosis patients. Urol Clin North Am. 2010;37:547–57.CrossRefGoogle Scholar
  31. 31.
    Marrie RA, Cutter G, Tyry T, Vollmer T, Campagnolo D. Disparities in the management of multiple sclerosis-related bladder symptoms. Neurology. 2007;68:1971–8.CrossRefGoogle Scholar
  32. 32.
    Mayo ME, Chetner MP. Lower urinary tract dysfunction in multiple sclerosis. Urology. 2007;39:67–70.CrossRefGoogle Scholar
  33. 33.
    Betts CD, D'Mellow MT, Neurology CFJO. Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis. J Neurol Neurosurg Psychiatry. 1993;56:245–50.CrossRefGoogle Scholar
  34. 34.
    Gallien P, Robineau S, Nicolas B, Le Bot MP, Brissot R, Verin M. Vesicourethral dysfunction and urodynamic findings in multiple sclerosis: a study of 149 cases. Arch Phys Med Rehabil. 1998;79:255–7.CrossRefGoogle Scholar
  35. 35.
    Murphy AM, Bethoux F, Stough D, Goldman HB. Prevalence of stress urinary incontinence in women with multiple sclerosis. Int Neurourol J. 2012;16:86–90.CrossRefGoogle Scholar
  36. 36.
    Kasabian NG, Krause I, Brown WE, Khan Z, Nagler HM. Fate of the upper urinary tract in multiple sclerosis. Neurourol Urodyn. 1995;14:81–5.CrossRefGoogle Scholar
  37. 37.
    Amarenco G, Kerdraon J, Denys P. Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases. Rev Neurol (Paris). 1995;151:722–30.Google Scholar
  38. 38.
    de Sèze M, Ruffion A, Denys P, Joseph P-A, Perrouin-Verbe B, GENULF. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler 2007;13:915–928.Google Scholar
  39. 39.
    Panicker J, Haslam C. Lower urinary tract dysfunction in MS: management in the community. Br J Community Nurs. 2009;14:474–476–478–80.CrossRefGoogle Scholar
  40. 40••.
    Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al. Fourth international consultation on incontinence recommendations of the international scientific committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn Wiley subscription services, Inc, a Wiley company. 2010;29:213–40. International Continence Society recommendations on the evaluation for urinary incontinence. Google Scholar
  41. 41.
    Fletcher SG, Dillon BE, Gilchrist AS, Haverkorn RM, Yan J, Frohman EM, et al. Renal deterioration in multiple sclerosis patients with neurovesical dysfunction. Mult Scler. 2013;19:1169–74.CrossRefGoogle Scholar
  42. 42.
    Lawrenson R, Wyndaele JJ, Vlachonikolis I, Farmer C, Glickman S. Renal failure in patients with neurogenic lower urinary tract dysfunction. Neuroepidemiology. 2001;20:138–43.CrossRefGoogle Scholar
  43. 43.
    Litwiller SE, Frohman EM, Zimmern PE. Multiple sclerosis and the urologist. JURO. 1999;161:743–57.Google Scholar
  44. 44.
    de Ridder D, Van Der Aa F, Debruyne J, D’hooghe M-B, Dubois B, Guillaume D, et al. Consensus guidelines on the neurologist's role in the management of neurogenic lower urinary tract dysfunction in multiple sclerosis. Clin Neurol Neurosurg. 2013;115:2033–40.CrossRefGoogle Scholar
  45. 45.
    Ghezzi A, Carone R, Del Popolo G, Amato MP, Bertolotto A, Comola M, et al. Recommendations for the management of urinary disorders in multiple sclerosis: a consensus of the Italian multiple sclerosis study group. Neurol Sci. 2011;32:1223–31.CrossRefGoogle Scholar
  46. 46.
    Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol Elsevier Ltd. 2015;14:720–32.CrossRefGoogle Scholar
  47. 47••.
    National Institute for Health and Care Excellence. Urinary incontinence in neurological disease: assessment and management. National institute for health and care excellence; 2019 May. p. 1–47. United Kingdom guidelines for the treatment of neurogenic bladder.Google Scholar
  48. 48••.
    Tornic J, Panicker JN. The management of lower urinary tract dysfunction in multiple sclerosis. Curr Neurol Neurosci Rep. 2018:1–11. Recent review on the management of lower urinary tract dysfucntion in patients with multiple sclerosis.Google Scholar
  49. 49••.
    Cetinel B, Tarcan T, Demirkesen O, Ozyurt C, Sen I, Erdogan S, et al. Management of lower urinary tract dysfunction in multiple sclerosis: a systematic review and Turkish consensus report. Neurourol Urodyn. 2013;32:1047–5.7 Turkish consensus report for the management of lower uriary tract dysfunction in patients with multiple sclerosis.Google Scholar
  50. 50••.
    de Sèze M, Ruffion A, Denys P, Joseph P-A, Perrouin-Verbe B. International francophone neuro-urological expert study group (GENULF). The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler. 2007;13:915–28. Management guidelines for neurogenic bladder in multiple sclerosis patients. proposed by the International Francophone Neuro-Urological study group. Google Scholar
  51. 51.
    Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. Summary of European Association of Urology (EAU) guidelines on neuro-urology. Eur Urol. 2016;69:324–33.CrossRefGoogle Scholar
  52. 52.
    Winters JC, Dmochowski RR, Goldman HB, Herndon CDA, Kobashi KC, Kraus SR, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012;188:2464–72.CrossRefGoogle Scholar
  53. 53.
    Ciancio SJ, Mutchnik SE, Rivera VM, Boone TB. Urodynamic pattern changes in multiple sclerosis. Urology. 2001;57:239–45.CrossRefGoogle Scholar
  54. 54.
    Madersbacher H. The various types of neurogenic bladder dysfunction: an update of current therapeutic concepts. Spinal Cord. 1990;28:217–29.CrossRefGoogle Scholar
  55. 55.
    Powell CR. Not all neurogenic bladders are the same: a proposal for a new neurogenic bladder classification system. Transl Androl Urol. 2016;5:12–21.Google Scholar
  56. 56.
    Wolf JS, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179:1379–90.CrossRefGoogle Scholar
  57. 57.
    Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. 2nd ed. Clin Infect Dis. 2005;40:643–54.CrossRefGoogle Scholar
  58. 58•.
    Cameron AP, Campeau L, Brucker BM, Clemens JQ, Bales GT, Albo ME, et al. Best practice policy statement on urodynamic antibiotic prophylaxis in the non-index patient. Neurourol Urodyn. 2017;36:915–26. Best practice statement on the use of prophylactic antibiotics in non-index patients.Google Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Urologic SurgeryUniversity of California, Davis School of MedicineSacramentoUSA

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