Evaluation and management of neurogenic vesicourethral dysfunction in multiple sclerosis

Multiple sclerosis (MS), a chronic inflammatory disease of the nervous system, is the most common cause of progressive neurologic disability in young adults. In addition to spasticity, tremors, weakness, sensory disturbances, depression, cognitive problems, and sexual dysfunction, neurogenic vesicourethral dysfunction (VUD) is a prevalent and destructive manifestation of the disease that severely affects quality of life. Evaluation of this disorder requires insight into the progressive yet unpredictable neurologic changes caused by MS. Urinary symptoms are poorly specific for the presence of VUD, although duration of disease and disability status do correlate with adverse urodynamic findings. Limited evidence exists regarding exactly when urodynamic evaluation should be initiated upon referral, although an algorithm following urinary retention can serve as a guide. This review aims to detail what is currently known regarding the evaluation and management of VUD in MS such that a flexible, patient-centered approach can be implemented.