Multiple sclerosis and the urologist

Purpose: We provide an updated reference detailing the neurological and uro logical state of the art approach to multiple sclerosis (MS) with special e mphasis on the pathology and physiology, effects on the genitourinary tract , diagnostic evaluation, and treatment of neurological and urological manif estations. Materials and Methods: A MEDLINE computerized reference search and manual b ibliography review were performed to find pertinent peer reviewed articles on the neurological and urological manifestations and treatment of MS. A me ta-analysis was performed on the urodynamic findings of 22 studies involvin g 1,882 patients from well-defined MS populations. Results: The majority of patients with MS have genitourinary symptoms rangi ng from urgency, urge incontinence and frequency to urinary retention. Symp toms do not accurately reflect the underlying urological pathology but para llel pyramidal tract dysfunction. Urodynamic evaluation has an important ro le in determining proper bladder management. The most common urodynamic fin ding is detrusor hyperreflexia in 62% of these patients, followed by detrus orsphincter dyssynergia in 25% and hypocontractility in 20%. Less than 1% o f patients has renal deterioration and most may be treated with conservativ e measures. If conservative measures fail, new forms of bladder reconstruct ion and diversion may be effectively used. The incidence of sexual dysfunct ion is up to 80% in men and 72% in women, and treatment focuses on improvem ent 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 shoul d be actively involved in multispecialty treatment of these patients.