Neurourologic Abnormalities in Multiple Sclerosis

Abstract

Multiple sclerosis [MS] is a demyelinating disease of the CNS, often producing abnormalities in sexual function and urinary control. Eighty-six patients with this disorder were referred to the neurourologic facilities for evaluation (45 women and 41 men). Symptomatic voiding dysfunction was present in 84 patients (97%). Sexual dysfunction was present in 29 of the 41 men (71%). Neurourologic evaluation was performed by rapid-fill CO2 cystometry and perineal floor needle electromyography. Several neurourologic patterns were identified in MS patients: the most common cystometry pattern was detrusor hyperreflexia (76%), and the most common electromyography finding was vesico-sphincter dyssynergia (50%). Voiding symptoms alone did not correlate with neurourologic findings. The presence of bilateral extensor plantar reflexes indicated the possibility of vesico-sphincter dyssynergia. The addition of sacral-evoked responses to the neurourologic evaluation was useful in the identification and localization of occult sacral cord pathology and was of special significance to men with sexual dysfunction undergoing evaluation for neurogenic impotence. The combination of abnormal perineal electromyography, abnormal sacral latency and destrusor hyperreflexia was suggestive of multilevel spinal cord dysfunction and, possibly, has diagnostic as well as therapeutic significance. Neurourologic patterns changed in 4 of 9 patients re-evaluated because of symptom changes or poor treatment responses. Neurourologic testing in MS patients may be used to identify pathologic lesions, characterize sexual and voiding dysfunctions, corroborate neurologic diagnosis in doubtful cases and form a basis for rational treatment planning.