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Multiple sclerosis produces significant changes in urinary bladder innervation which are partially reflected in the lower urinary tract functional status-sensory nerve fibers role in detrusor overactivity

Department and Clinic of Urology, Faculty of Medical Sciences, Medical Academy in Warsaw, Polandpradziszewski{at}neostrada.pl

R Crayton

Medical University of Warsaw, Department of Experimental and Clinical Physiology, Medical Academy in Warsaw, Poland

J Zaborski

Specialist Hospital Miedzylesie in Warsaw, Department of Neurology, Warsaw, Poland

A Czonkowska

Institute for Psychiatry and Neurology in Warsaw, Department and Clinic of Neurology, Medical Academy in Warsaw, Poland

A Borkowski

Department and Clinic of Urology, Faculty of Medical Sciences, Medical Academy in Warsaw, Poland

A Bossowska

Department of Human Physiology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland

M Majewski

Department of Human Physiology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland

Background

Detrusor overactivity is often observed in patients with multiple sclerosis (MS), and neurotoxins are emerging as second-line therapies albeit with different degrees of success per patient basis.

Objective

To investigate lower urinary tract (LUT) functional status and bladder innervation (calcitonin gene related peptide [CGRP] and substance P [SP] positive nerve fibers) in patients with MS.

Method

Eighteen MS patients with LUT symptoms underwent urodynamic investigations, and six non-MS patients undergoing cystoscopy due to microscopic hematuria served as controls. Cold cut bladder biopsies were taken from the bladder trigone region. Neurotransmitter expression was determined by individual immunohistochemical staining.

Results

Two distinct groups could be distinguished: group 1 with pronounced neurogenic detrusor overactivity and mild outflow obstruction; group 2 with some degree of neurogenic detrusor overactivity, detrusor hypocontractility during voiding, and high degree of an outflow obstruction. The presence of SP and CGRP immunoreactive + fiber density was observed in greater numbers in group 1.

Conclusion

Density of CGRP and SP positive nerve fibers within the urinary bladder of patients with MS may be suggestive of functional status of the lower urinary tract, namely denser innervation is observed in patients with mild outflow obstruction and strong detrusor overactivity. This observation could be useful when planning second-line treatment (neurotoxins) in these patients. Patients with denser innervation probably will respond better to such a therapy.

Key Words: capsaicin • detrusor overactivity • multiple sclerosis • vanilloid

Multiple Sclerosis, Vol. 15, No. 7, 860-868 (2009)
DOI: 10.1177/1352458509106210


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