Editing Neurogenic LUT Dysfunction (section)

=== Multiple sclerosis ===
* Primarily a disease of adults ages 20-50 years with a 2x predilection for women
* The disease is believed to be immune mediated and is characterized by neural demyelination in the brain and spinal cord; it is characterized, in general, by axonal sparing'''. The demyelinating process most commonly involves the''' lateral corticospinal (pyramidal) and reticulospinal columns of the '''cervical''' '''spinal cord'''
* '''Common symptoms include optic nerve dysfunction, pyramidal tract abnormalities (hyper-reflexia), ataxia, bowel dysfunction, neurogenic bladder, and bowel and sexual dysfunction'''
* 50-90% report voiding symptoms at some time; the prevalence of incontinence is cited as 37-72%
* '''Urodynamic findings'''
** '''Detrusor overactivity is the most common abnormality detected'''
** '''In general, the smooth sphincter is synergic'''
** '''Striated sphincter dyssynergia coexists with overactivity in 30-65% of patients'''
** The prevalence of coexistent impaired detrusor contractility or areflexia ranges from 12-38%, a phenomenon that can considerably complicate treatment efforts
** One must be careful to distinguish urodynamic pseudodyssynergia from true striated sphincter dyssynergia
** Sensation is frequently intact in these patients
* '''The most common functional classification applicable to patients with LUT dysfunction secondary to MS would be storage failure secondary to detrusor overactivity. This is commonly complicated by striated sphincter dyssynergia, with varying sequelae based on the patient’s ability to empty completely at acceptable voiding pressures'''. Other abnormalities, and especially combined deficits, are obviously possible
* Progressive neurologic disease in patients with MS rarely causes upper urinary tract damage, even when severe spasticity and disability exist
* '''Management'''
** At present there is no consensus on optimal bladder management for patients with MS, and management is most commonly predicated on symptomatic and urodynamic findings.
** '''Caution should be exercised in recommending irreversible therapeutic options, because a significant proportion of patients with MS, both with and without new symptoms''', will develop changes in their detrusor compliance and urodynamic pattern.
*** Surgical intervention for MS appears to be diminishing with improved pharmacologic management and the realization of the alternating neurologic picture of lower urinary dysfunction associated with MS