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The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines

Unité d'Evaluation et de Traitement du handicap Urinaire, Service de Médecine Physique et de réadaptation, CHU Pellegrin, Equipe de recherche Handicap et Système nerveux, Université Victor Segalen Bordeaux 2, 33076 Bordeaux Cedex, France, marianne.de-seze{at}chu-bordeaux.fr

Alain Ruffion

Service d'Urologie, Hôpital Henry Gabrielle, CHU Lyon, 69565 Saint Genis Laval Cedex, France

Pierre Denys

Service de Rééducation neurologique, Hôpital Raymond Poincaré, APHP, 92380 Garches Cedex, France

Pierre-Alain Joseph

Unité d'Evaluation et de Traitement du handicap Urinaire, Service de Médecine Physique et de réadaptation, CHU Pellegrin, Equipe de recherche Handicap et Système nerveux, Université Victor Segalen Bordeaux 2, 33076 Bordeaux Cedex, France

Brigitte Perrouin-Verbe

Service de Médecine Physique et de Réadaptation, Hôpital Saint Jacques, CHU de Nantes, 44093 Nantes Cedex, France

International Francophone Neuro-Urological expert study group (GENULF)

Vesicourethral dysfunction is very frequent in multiple sclerosis (MS) and has functional consequences for patients' quality of life and also an organic impact following complications of the neurogenic bladder on the upper urinary tract. While the functional impact and its management are well documented in the literature, the organic impact remains underestimated and there are no consensual practical guidelines for the screening and prevention of MS neurogenic bladder complications. The aim of this review of the literature, focused on identifying the risk factors of urinary tract complications in MS, is to put forward well informed considerations to help in the definition of practical guidelines for the follow-up of the neurogenic bladder in MS in order to improve its prevention and patient management. Four main risk factors have been identified for upper urinary tract damage: the duration of MS, the presence of an indwelling catheter, high-amplitude neurogenic detrusor contractions and permanent high detrusor pressure. Detrusor-sphincter dyssynergia, age over 50 and male sex may form three additional risk factors. Recommendations for long-term urological follow-up, taking into account these specific risks are constructed according to the procedures recommended by the French Health Authorities. Multiple Sclerosis 2007; 13: 915-928. http://msj.sagepub.com

Key Words: multiple sclerosis • neurogenic bladder • overactive bladder • upper urinary tract abnormalities • ureterohydronephrosis • urinary tract infection

This version was published on August 1, 2007

Multiple Sclerosis, Vol. 13, No. 7, 915-928 (2007)
DOI: 10.1177/1352458506075651


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