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Urogenital dysfunction in patients with multiple sclerosis

  • David B. Vodušek (a1)


The occurrence of urogenital dysfunction as an isolated early symptom in multiple sclerosis (MS) is rare, but the prevalence thereof becomes high with progression of disease. Lower urinary tract dysfunction may add to the cause of death (particularly through urinary infections), but both urinary and sexual dysfunction significantly affect quality of life of patients.

Both storage and evacuation of urine may be affected by MS, and ultimatively the functional diagnosis can only be made by urodynamic testing. As upper urinary tract affection is, however, rare (and can be prevented by timely ultrasound imaging), a first stage diagnostics in the MS center by the neurologist and specialized nurse is appropriate. History, urine tests and post void residual urine determination (preferably by ultrasound) should provide necessary data for treatment of infections, and also symptomatic management of frequency, urgency and incontinence by bladder training, anticholinergics, and intermittent self catheterization (as indicated); the referral to urologist may be reserved for patients who fail first line treatment. Treatment in the late stages of MS is as yet little researched, but eventually a suprapubic catheter is the preferred method of bladder emptying. Sexual dysfunction should be actively sought in MS patients (in men erectile and ejaculation dysfunction, in women deficient lubrication and genital hyper- or hyposensitivity are frequent). Clinical examination contributes little to clarification of neurogenic sexual dysfunction, but defines the extent of other deficits due to MS, which may be relevant for sexual counseling (spasticity, sensory loss). Sildenafil has been demonstrated to be effective in treatment of men, but not in women. Other management options exist, and the doctor and nurse in the MS center should be proactive in providing first line counseling and management.



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1.Kalsi, V, Fowler, CJ. Therapy Insight: bladder dysfunction associated with multiple sclerosis. Nature Clinical Practice Urology 2005;2:492501.
2.Goldstein, I, Siroky, MB, Sax, DS, et al.Neurourologic abnormalities in multiple sclerosis. J Urol 1982;128:541545.
3.Bemelmans, BLH, Hommes, OR, Van Kerrebroeck, PEV, Lemmens, WAJG, Doesburg, WH, Debruyne, FMJ. Evidence for early lower urinary tract dysfunction in clinically silent multiple sclerosis. J Urol 1991;145:12191224.
4.Nortvedt, MW, Riise, T, Myhr, KM, Landtblom, AM, Bakke, A, Nyland, HI. Reduced quality of life among multiple sclerosis patients with sexual disturbance and bladder dysfunction. Mult Scler 2001;7(4):231235.
5.Redelings, MD, McCoy, L, Sorvillo, F. Multiple sclerosis mortality and patterns of comorbidity in the United States from 1990 to 2001. Neuroepidemiology 2006;26:102107.
6.Wyndaele, JJ, Kovindha, A, Madersbacher, H, Radziszewski, P, Ruffion, QA, Schursch, B, Igawa, Y, Sakakibara, R. Neurologic urinary and faecal incontinence. In Incontinence (Abrams, P, Cardozo, L, Khoury, S, and Wein, A Eds.). Health Publications Ltd./ Editions 21, Paris 2009, pp 797960.
7.Litwiller, SE, Frohman, EM, Zimmern, PE. Multiple sclerosis and the urologist. J Urol 1999;161:743757.
8.Ciancio, SJ, Mulchnik, SE, Rivera, VM, Boone, TB. Urodynamic pattern changes in multiple sclerosis. Urology 2001;57:239245.
9.Rodi, Z, Vodušek, DB, Denišlić, M.Clinical uro-neurophysiological investigation in multiple sclerosis. Eur J Neurol 1996;3:574580.
10.Lycklama à Nijeholt, G, Barkhof, F.Differences between subgroups of MS: MRI findings and correlation with histopa-thology. J Neurol Sci. 2003;206:173174.
11.Lawrenson, R, Wyndaele, JJ, Vlachonicolis, I, Farmer, C, Glick-man. Renal failure in patients with neurogenic lower urinary tract dysfunction. Neuropepidemiology 2001;20:138143.
12.Rotar, M, Trsinar, B, Kisner, K, Barbic, M, Sedlar, A, Gruden, J, Vodusek, DB: Correlations between the ICIQ-UI short form and urodynamic diagnosis. Published Online: 03 3 2009, DOI: 10.1002/nau.20689.
13.Barbalias, GA, Nikiforidis, G, Liatsikos, EN.Vesicourethral dysfunction associated with multiple sclerosis: clinical and urodynamic perspectives. J Urol 1998;160:106111.
14.Hosker, G, Rosier, R, Gajewski, J, Sand, P.Dynamic testing. In Incontinence (Abrams, P, Cardozo, L, Khoury, S, and Wein, A Eds.). Health Publications Ltd./ Editions 21, Paris 2009:413522.
15.Hilton, P, Hertogs, K, Stanton, SL.The use of desmopressin (DDAVP) for nocturia in women with multiple sclerosis. J Neurol Neurosurg Psychiatry 1983;46:854855.
16.MacDonald, R, Monga, M, Fink, HA, Wilt, TJ.Neurotoxin treatments for urinary incontinence in subjects with spinal cord injury or multiple sclerosis: A systematic review of effectiveness and adverse effects. J Spinal Cord Med 2008;31:157165.
17.Gallien, P, Reymann, JM, Amarenco, G, Nicolas, B, de Seze, M, Bellissant, E.Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients. J Neurol Neurosurg Psychiatry 2005;76:16701676.
18.Primus, G, Kramer, G.Maximal external electrical stimulation for treatment of neurogenic or non-neurogenic urgency and/or urge incontinence. Neurourol Urodyn 1996;15:187194.
19.Chartier-Kastler, E, Richard, F, Denys, P, Perrigot, M, Bussel, B, Chatelain, C.S3 sacral neuromodulation in patients with chronic refractory miction disorders. Presse Méd 1997;26:466467.
20.Centonze, D, Petta, F, Versace, V, Rossi, S, Torelli, F, Prosperetti, C, Rossi, S, Marfia, GA, Bernardi, G, Koch, G, Miano, R, Boffa, L, Finazzi-Agro, E. Effects of motor cortex rTMS on lower urinary tract dysfunction in multiple sclerosis (In Process Citation). Mult Scler 2007;13:269271.
21.Amarenco, G, Bosc, S, Boiteau, F.Urologic complications of multiple sclerosis. 180 cases. Presse Med 1996;25:10071010.
22.De Ridder, D, Ost, D, Van der Aa, F, Stagnaro, M, Beneton, C, Gross-Paju, K, Eelen, P, Limbourg, H, Harper, M, Segal, JC, Fowler, CJ, Nordenbo, A.Conservative bladder management in advanced multiple sclerosis. Mult Scler 2005;11:694699. Review.
23.Addis, IB, Van Den Eeden, SK, Wassel-Fyr, CL, et al.Sexual activity and function in middle aged and older women. Obstet Gynecol 2006;107:755764.
24.McCabe, MP. Exacerbation of symptoms among people with multiple sclerosis: impact of sexuality. Arch Sex Behav 2004;33:593601.
25.Beric, A, Light, JK.Anorgasmia in anterior spinal cord syndrome. J Neurol Neurosurg Psychiatry 1993;56:548551.
26.Smith, EM, Bodner, DR.Sexual dysfunction after spinal cord injury. Urol Clin North Am 1993;20:535542.
27.Lundberg, PO. Physiology of female sexual function and effect of neurologic disease. In Neurology of Bladder, Bowel, and Sexual Dysfunction. (Fowler, CJ Ed.). Boston, Butterworth-Heinemann 1999, p 33.
28.Giuliano, FA, Rampin, O, Benoit, G, et al.Neural control of penile erection. In Impotence. (Melman, A, ed.). Urol Clin North Am 1995;22: pp 747766.
29.Sipski, ML, Alexander, CJ, Rosen, RC.Physiological parameters associated with psychogenic sexual arousal in women with complete spinal cord injuries. Arch Phys Med Rehabil 1995;76:811818.
30.Brindley, GS, Gillan, P.Men and women who do not have orgasms. Br J Psychiatry 1982;140:351356.
31.Janus, SS, Janus, CL.The Janus Report on Sexual Behavior. New York, John Wiley & Sons, 1993.
32.Marson, L. Central nervous system control. In Textbook of Erectile Dysfunction (Carson, C, Kirby, R, Goldstein, I, Eds.). Oxford, Isis Medical Media, 1999, p. 73.
33.Zivadinov, R, Zorzon, M, Locatelli, L, et al.Sexual function in multiple sclerosis: a MRI, neurophysiological and urodynamic study. J Neurol Sci 2003;210:7376.
34.Betts, CD. Bladder and sexual dysfunction in multiple sclerosis. In Neurology of Bladder, Bowel, and Sexual Dysfunction. (Fowler, CJ Ed.). Boston, Butterworth-Heinemann 1999, p 289.
35.Ghezzi, A, Zaffaroni, M, Baldini, S, et al.Sexual dysfunction in male multiple sclerosis patients in relation to clinical findings. Eur J Neurol 1996;3:462.
36.Fowler, CJ, Miller, JR, Sharief, MK, et al.A double blind, randomised study of sildenafil citrate for erectile dysfunction in men with multiple sclerosis. J Neurol Neurosurg Psychiatry 2005;76:700705.
37.Valleroy, M, Kraft, G: Sexual dysfunction in multiple sclerosis. Arch Phys Med Rehabil 1984;65:125128.
38.Minderhoud, JM, Leemhuis, JG, Kremer, J, et al.Sexual disturbances arising from multiple sclerosis. Acta Neurol Scand 1984;70:299306.
39.Barak, Y, Achiron, A, Elizur, A, et al.Sexual dysfunction in relapsing-remitting multiple sclerosis: magnetic resonance imaging, clinical, and psychological correlates. J Psychiatry Neurosci 1996;21:255258.
40.Shaughnessy, L, Schuchman, M, Ghumra, M, et al.Sexual dysfunction in multiple sclerosis. In Sexual and Reproductive Neurorehabilitation. (Aisen, M. Ed.). Totowa, NJ, Humana Press, 1997, p 169.
41.Yang, CC, Bowen, JR, Kraft, GH, et al.Cortical evoked potentials of the dorsal nerve of the clitoris and female sexual dysfunction in multiple sclerosis. J Urol 2000;164:20102013.
42.Hulter, BM, Lundberg, PO.Genital vibratory perception threshold (VPT) measurements in women with sexual dysfunction and/or sexual pain disorders. Eur J Sexual Health 2006;15 (Suppl. S33).
43.Rosen, RC, Riley, A, Wagner, G, et al.An international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822.
44.NIH Consensus Development Panel on Impotence. Impotence. JAMA 1993;270:8390.
45.Wagner, TH, Patrick, DL, McKenna, SP, et al.Cross-cultural development of a quality of life measure for men with erection difficulties. Qual Life Res 1996;5:443449.
46.Rosen, R, Brown, C, Heiman, J, et al.The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000;26:191208.
47.Lue, TF. Editorial comment. J Urol 1996;156:552.
48.Dasgupta, R, Wiseman, OJ, Kanabar, G, et al.Efficacy of sildenafil in the treatment of female sexual dysfunction due to multiple sclerosis. J Urol 2004;171:11891193.
49.Salonia, A, Rigatti, P, Montorsi, F.Sildenafil in erectile dysfunction: a critical review. Curr Med Res Opin 2003;19:241262.
50.Zusman, RM, Morales, A, Glasser, DB, et al.Overall cardiovascular profile of sildenafil citrate. Am J Cardiol 1999;83:35C.
51.Betts, CD, Jones, SJ, Fowler, CG, et al.Erectile dysfunction in multiple sclerosis. Brain 1994;117:13031310.
52.Lundberg, PO. Priapism. Review. Scand J Sexol 2000;3:1324.
53.Rivas, D, Chancellor, M.Complications associated with the use of vacuum constriction devices for erectile dysfunction in the spinal cord injured population. J Am Paraplegia Soc 1994;17:136139.
54.Singer, C. Erectile and ejaculatory disturbances: overview of diagnosis and treatment. In Sexual Dysfunction: A Neuro-Medical Approach. (Singer, C, Weiner, WJ, Eds.). Armonk, NY, Futura, 1994, p 45.
55.Kandeel, FR, Koussa, VK, Swerdloff, RS.Male sexual function and its disorders: physiology, pathophysiology, clinical investigation, and treatment. Endocr Rev 2001;22:342388.

Urogenital dysfunction in patients with multiple sclerosis

  • David B. Vodušek (a1)


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