BLADDER AND SPHINCTER DYSFUNCTION IN MULT IPLE-SCLEROSIS - CLINICAL, URODYNAMIC AND NEUROPHYSIOLOGIC STUDY OF 225 CASES

Two hundred and twenty-five patients with multiple sclerosis and bladd er dysfunction were evaluated. 72% has urinary incontinence, 46% dysur ia and 24% urinary retention. Detrusor hyperreflexia was the most comm on finding on cystometry (70%) and 9% of patients had areflexia. Coaxi al needle electromyography was performed on all patients and 82% had d etrusor-sphincter dyssynergia. Cortical evoked potentials following st imulation of the pudendal nerve were delayed in 72% and sacral evoked latency in 16% especially in patients with incontinence secondary to o veractive bladder (25%), suggesting a conus medullaris lesion in these cases. Urologic complications were noted in 40%, with benign lesions 24% (diverticula, urinary infections) and serious lesions in 16% (hydr onephrosis, pyelonephritis, renal reflux). The most common treatment w as anticholinergic drugs (efficacy in 92%), alphablockers agents (effi cacy in 60%) and autocatheterism in 28%.