Therapy Insight: Bladder Dysfunction Associated With Multiple Sclerosis

Vinay Kalsi; Clare J. Fowler

Nat Clin Pract Urol. 2005;2(10):492-501.

Conclusion

MS and its associated bladder symptoms have a considerable negative impact on patients' quality of life and, although progression of the neurological disease is proving difficult to halt, much can now be done to improve bladder control. Intermittent self-catheterization can make a crucial difference to management of patients in whom incomplete voiding is contributing to bladder dysfunction. The development of more selective oral agents is to be welcomed, as is the exciting discovery of intradetrusor botulinum neurotoxin injections to treat severely affected patients. Surgery has comparatively less to offer, and effective management is becoming possible largely as an outpatient procedure. Many patients' bladder problems are now being managed in the same clinic as cares for their underlying neurological disease, although urologic invention might still be necessary to deal with stone formation, recurrent infections and placement of a suprapubic catheter.

Overall, the options for bladder management in MS have improved greatly, and more patients are able to receive effective treatment for very distressing symptoms that would otherwise compound their neurological disability.

Review Criteria

PubMed was searched for articles published from January 1965 to March 2005 using the terms "multiple sclerosis", "bladder", and "incontinence". Additional papers were also obtained from the bibliographies of selected articles. The selection of papers was based on relevance on subject matter, clinical importance and scientific value.

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Reprint Address

Correspondence: Clare J. Fowler, Department of Uro-Neurology, Internal mailbox 71, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. Email: c.fowler@ion.ucl.ac.uk

Cite this: Therapy Insight: Bladder Dysfunction Associated With Multiple Sclerosis - Medscape - Oct 01, 2005.

Table 1. Summary of Urodynamic Abnormalities Found in Patients With Multiple Sclerosis
Urodynamic abnormality	Incidence in patients with MS (%)
Neurogenic detrusor overactivity without bladder outlet obstruction	62
Neurogenic detrusor overactivity with DSD	25
Detrusor underactivity	20
None	10

DSD, detrusor-sphincter dyssynergia; MS, multiple sclerosis.

Table 2. Anticholinergic Agents Used to Treat Symptoms of Detrusor Overactivity
Generic name	Trade name	Dose (mg)	Frequency	Receptor subtype selectivity	Elimination half-life of parent drug (h)
Propantheline bromide	Pro-Banthine^® (Concord Pharmaceuticals Ltd, Horsham, UK)	15	tds	Nonselective	<2
Tolterodine tartrate	Detrusitol^® (Pfizer Ltd, Walton-on-the-Hill, UK)	2	bd	Nonselective	2.4
Tolterodine tartrate	Detrusitol^® XL	4	od	Nonselective	8.4
Trospium chloride	Regurin^® (Galen Ltd, Craigavon, UK)	20	bd	Nonselective	20
Oxybutynin hydrochloride	Ditropan^® (ALZA Corporation, Alto, CA)	2.5-5	bd to qds	Nonselective	2.3
Oxybutynin hydrochloride XL	Lyrinel^® XL (Janssen-Cilag Ltd, High Wycombe, UK)	5-30	od	Nonselective	13.2
Propiverine hydrochloride	Detrunorm^® (Amdipharm plc, Basildon, UK)	15	od to qds	Nonselective	4.1
Darifenacin	Emselex^® (Pfizer Inc., New York, NY)	7.5-15	od	Selective muscarinic M3 receptor antagonist	3.1
Solifenacin succinate	Vesicare^® (Yamanouchi Pharma Ltd, West Byfleet, UK)	5-10	od	Selective muscarinic M2 and M3 receptor antagonist	40-68

bd, twice daily; od, once daily; qds, four times daily; tds, three times daily; XL, extended life.

Table 3. The Ashworth Scale Used as a Clinical Measure of Spasticity
Score	Ashworth Scale
0	No increase in tone
1	Slight increase in tone giving a catch when the limb is moved in flexion or extension
2	More marked increase in tone but limb easily flexed
3	Considerable increase in tone; passive movement difficult
4	Limb rigid in flexion or extension

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