Dysfunction of the detrusor and urethra in multiple sclerosis: the role of drug therapy.
Urinary tract disorders secondary to multiple sclerosis are common. In this series of 24 patients with multiple sclerosis, 5 had normal function of the detrusor, 3 had detrusor hypotonicity and 16 had detrusor hyperreflexia. The proximal urethra was evaluated using radiologic and electromyographic techniques. These studies showed that 5 patients had a normal urethra, 15 had some degree of somatic dyssynergia and 3 had sympathetic dyssynergia. Detrusor hyperreflexia with somatic dyssynergia was found in 11 patients and was the most common pattern. The therapeutic response to standard pharmacologic preparations was also evaluated. The regimen was based on the clinical and urodynamic findings for each patient. Dicyclomine hydrochloride was the drug of choice for detrusor hyperreflexia, bethanechol chloride for hypotonicity, dantrolene sodium for somatic dyssynergia and phenoxybenzamine hydrochloride for sympathetic dyssynergia. The authors found that most of their patients were amenable to drug therapy, the exception being those with advanced neurologic lesions.
D000328:Adult; D018723:Bethanechol; D001626:Bethanechol Compounds / Q000627:therapeutic use; D003620:Dantrolene / Q000627:therapeutic use; D004025:Dicyclomine / Q000627:therapeutic use; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D010643:Phenoxybenzamine / Q000627:therapeutic use; D012021:Reflex, Abnormal / Q000188:drug therapy* / Q000209:etiology; D014522:Urethral Diseases / Q000188:drug therapy* / Q000209:etiology; D001745:Urinary Bladder Diseases / Q000188:drug therapy* / Q000209:etiology
D001626:Bethanechol Compounds; D018723:Bethanechol; D010643:Phenoxybenzamine; D004025:Dicyclomine; D003620:Dantrolene