title: Role of limited evaluation and aggressive medical management in multiple sclerosis: a review of 113 patients.
abstract: Multiple sclerosis has frequent urological manifestations. Medical management, based on clinical symptoms and urodynamic findings, incorporates clean intermittent catheterization, oral pharmacological agents (that is oral oxybutynin) or their combination (the desired end point of treatment being complete retention with clean intermittent catheterization). Our objectives were to evaluate the efficacy of medical management in multiple sclerosis patients, determine the incidence of hydronephrosis at presentation and during treatment, and evaluate the impact of electromyography on patient management. We reviewed retrospectively 113 patients with documented multiple sclerosis (mean age 45 years, range 20 to 75 years and mean followup 41 months, range 6 to 136 months). Presenting symptoms were irritative alone or combined with obstructive symptoms in 94 patients (83%). On cystometrography 79 patients (70%) had detrusor hyperreflexia and 17 (15%) had an areflexic bladder. Coaxial needle electromyography was performed on 54 patients and 15 (28%) had detrusor-sphincter dyssynergia. Patients with detrusor-sphincter dyssynergia had more advanced neurological disease. A total of 105 patients had radiological imaging of the upper tracts. Only 7 patients (6.6%) had hydronephrosis at presentation and all were stable or improved with medical management. No patient had hydronephrosis with aggressive medical management. No patient with detrusor-sphincter dyssynergia had hydronephrosis or elevated creatinine levels at presentation or during treatment. Medical management failed in 8 patients (7%) who required surgical intervention. Limited evaluation (voiding symptoms, post-void residual and cystometrography) of multiple sclerosis patients is sufficient to formulate an effective treatment program. Electromyography is not necessary in the routine evaluation of patients with documented multiple sclerosis. After baseline upper tract imaging, routine yearly evaluations are unnecessary (unless initially abnormal or indicated by a change in clinical status). Medical management of patients with multiple sclerosis is safe and effective. In this series, no patient had hydronephrosis on therapy, and only 7% of the patients failed aggressive medical management and required surgical intervention.
authors.affiliation: Kaiser Permanente Medical Center, Los Angeles, California.
authors.forename: L T
authors.initials: LT
authors.lastname: Sirls
authors.forename: P E
authors.initials: PE
authors.lastname: Zimmern
authors.forename: G E
authors.initials: GE
authors.lastname: Leach
mesh_terms: D000328:Adult; D000368:Aged; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D014555:Urination Disorders / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics