Lower urinary tract dysfunction is present in two of three patients with multiple sclerosis five years after the diagnosis.
Most frequent symptoms are related to neurogenic detrusor overactivity, often associated with detrusor-sphincter dyssynergia. From the end of the 1990s, there is growing evidence that neurogenic detrusor overactivity can be effectively managed by intradetrusorial injections of botulinum toxin type A. This treatment has shown, in different randomised placebo-controlled trials, to be safe and effective on clinical and urodynamic parameters with significant improvement in quality of life. The median duration of effect is in mean nine months. The vast majority of studies have been conducted with onabotulinumtoxinA. The dose of onabotulinumtoxinA commonly used to treat neurogenic detrusor overactivity in patients with multiple sclerosis is 200UI, even if in selected patients lower doses can be preferred. To be considered eligible for treatment, all patients should accept and be instructed to perform clean intermittent self-catheterisation, since the risk of increased post-void residual volume and/or urinary retention after injection is high, especially with 200UI of onabotulinumtoxinA. However, quality of life and patient satisfaction seem not to be affected by the need of intermittent catheterisation. The risk of urinary infection after the procedure is to be kept in mind, mainly in patients with multiple sclerosis, so that adequate antibiotic prophylaxis is highly recommended.
Written by:
Schurch B, Carda S. Are you the author?
Neurourology, Service of Physical Medicine and Neurorehabilitation, CHU Vaudois, 5, avenue Pierre-Decker, 1011 Lausanne, Switzerland.
Reference: Ann Phys Rehabil Med. 2014 Jun 5. pii: S1877-0657(14)01723-0.
doi: 10.1016/j.rehab.2014.05.004
PubMed Abstract
PMID: 24953702
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