Neurogenic Bladder

  1. Botulinum toxin a improves the quality of life of patients with Neurogenic Urinary Incontinence
    Eur Urol 2007 Sep;52(3):850-9

  2. Pharmacotherapy for Neurogenic Detrusor overactivity
    Am J Phys Med Rehabil 2006 Jun;85(6):536-45

  3. Urodynamic findings in Primary/Progressive Multiple Sclerosis are associated with increased volumes of plaques and Atrophy in the Central Nervous System
    Acta Neurol Scand 2004 Feb;109(2):100-5

  4. VesicoSphincteric Dysfunction in Multiple Sclerosis
    Arch Esp Urol 2001 Sep;54(7):697-701

  5. Renal failure with Neurogenic lower Urinary Tract dysfunction
    NeuroEpidemiology 2001 May;20(2):138-43

  6. Botulinum Toxin Urethral Sphincter injection to restore Bladder emptying in men and women with Voiding Dysfunction
    J Urol 2001 Apr;165(4):1107-1110

  7. Renal failure with Neurogenic lower Urinary Tract dysfunction
    NeuroEpidemiology 2001 May;20(2):138-43

  8. Bladder cooling Reflex in Multiple Sclerosis
    J Urol 2000 Oct;164(4):1280-4

  9. Bulk Files
    Urology and Multiple Sclerosis

  10. Bulk Files
    Neurogenic Detrusor HyperReflexia & Capsaicin

  11. Two Files
    Tolterodine (Detrol) for Detrusor HyperReflexia

  12. Two Files
    IleoVesicostomy management for Incontinence

  13. Lower Urinary Tract Dysfunction and Disability status in Multiple Sclerosis
    Arch Phys Med Rehabil 1999 Apr;80(4):437-41

  14. Urodynamic findings in Multiple Sclerosis
    J Urol 1998 Mar, 159:3, 972-6

  15. Frequent Urination problems in MS
    Urinary Definitions

  16. Urinary tract infections may trigger MS relapses
    Axone 1998 Jun;19(4):67-70

  17. Neurological & Urological state of Multiple Sclerosis
    J Urol 1999 Mar;161(3):743-57

  1. Bladder Dysfunction symptoms & treatment
    Hinyokika Kiyo 1997 Nov;43(11):765-769

  2. Urinary Incontinence in Multiple Sclerosis
    Urol Int 1997;59(3):197-199

  3. Single-institution experience in 110 patients with Botulinum Toxin A injection into Bladder or Urethra
    Urology 2005 Jan;65(1):37-41

  4. Relationship of Bladder Dysfunction to lesion site in Multiple Sclerosis
    J Urol 2003 Apr;169(4):1384-7

  5. VesicoUrethral Dysfunction associated with Multiple Sclerosis: clinical and Urodynamic perspectives
    J Urol 1998 Jul;160(1):106-11


Neurogenic Bladder Findings

Shimizu K, Yasukawa M, Yamamoto M, Hirao Y, Momose H, Kashiwai H, Kawata Y, Yamada K
Hinyokika Kiyo 1997 Nov;43(11):765-769
Nara Medical University, Dept of Urology, Japan
UI# 98098349

Clinical symptoms, Urodynamic findings, and Urological treatment of 35 patients with Neurogenic Bladder Dysfunction caused by Parkinson's Disease (11 patients), Multiple Sclerosis (10 patients), and SpinoCerebellar Degeneration (14 patients) were retrospectively reviewed.

Most of the patients had a relatively low stage of disease, when they were first seen by their Urologists. Chief Urological complaints were of Irritation in 63.6% of Parkinson's Disease and 64.3% of SpinoCerebellar Degeneration cases, compared with Obstruction in 80.0% of Multiple Sclerosis cases.

Cystometry revealed underactive Detrusor function in 69.2% of the patients with SpinoCerebellar Degeneration but no abnormalities in the patients with Parkinson's Disease or Multiple Sclerosis.

Of 34 patients, excluding one patient lost to follow-up, the period of Urological management ranged from one to 44 weeks with a mean of 11.0.

The final methods of Urinary drainage in 34 patients consisted of voluntary voiding in 20, clean Intermittent Catheterization in 11 including eight by Self-Catheterization, Incontinence into diaper in two, and Indwelling Catheter in one.

Five patients were compelled to change Urinary drainage method from voluntary voiding to clean Intermittent Catheterization because of increasing residual volume in four and progressing Bladder Deformity in one. However, none of them showed the clinical signs of primary disease progression.

These findings indicate that in patients with Parkinson's Disease, Multiple Sclerosis, and SpinoCerebellar Degeneration, the Urological symptoms can appear even in the early stage of disease.

In addition, close follow-up is important in the Urological management of Neurogenic Bladder patients with these diseases, because the disorders of the lower Urinary Tract may progress regardless of the status of the primary disease.


Urinary Incontinence In
Multiple Sclerosis

Yoshimura N, Nagahama Y, Ueda T, Yoshida O
Urol Int 1997;59(3):197-199
Kyoto University, Faculty of Medicine, Dept of Urology, Japan
UI# 98088718

We report a patient with Multiple Sclerosis who manifested Urinary Incontinence as a part of Paroxysmal attacks which were characterized by sudden onset, short duration, and frequent repetition. This phenomenon has not been described previously.

Urodynamic study during Paroxysmal attacks revealed Uninhibited Detrusor contractions with coordinated relaxation of External Urethral Sphincter muscle.

Neurological examination and Magnetic Resonance Imaging suggested that Paroxysmal Urinary Incontinence was induced by an ectopic excitation of the DeMyelinating lesion in the right Rostral Pons.

The location of which was similar to the Pontine Micturition Center reported in previous animal experiments. Treatment with Tegretol (Carbamazepine), an AntiEpileptic drug, suppressed the attacks including the associated Urinary Incontinence.


Single-Institution Experience In 110 Patients With Botulinum Toxin A Injection Into Bladder Or Urethra

Smith CP, Nishiguchi J, O'Leary M, Yoshimura N, Chancellor MB
Urology 2005 Jan;65(1):37-41
University of Pittsburgh School of Medicine, Department of Urology, Pittsburgh, Pennsylvania 15213, USA
PMID# 15667859

To detail, in a review, one institution's 6-year experience using Botulinum Toxin A (BTX-A) in the Bladder and Urethra in 110 patients for a variety of Lower Urinary Tract Disorders.

A total of 110 patients (35 men and 75 women, age range 19 to 82 years) received injections of BTX-A into the Bladder (n = 42) or urethra (n = 68).

Voiding dysfunction included Neurogenic Detrusor overactivity and/or Detrusor Sphincter Dyssynergia, Overactive Bladder, Bladder Neck Obstruction, and Interstitial Cystitis.

Under light sedation in most cases, patients were treated with either 100 to 200 U of BTX-A in 4 mL divided in equal doses into the four quadrants of the External Sphincter or by injection into the Bladder base using 100 to 300 U of BTX-A diluted in approximately 10 to 30 mL of sterile saline.

At last follow-up, 27 patients had received additional injections (up to six) at intervals of 6 months or longer.

All patients who underwent Bladder BTX-A injection had preoperative evidence of involuntary Detrusor contractions during Urodynamic testing.

Analysis of the 110 patients indicated that 67.3% reported a decrease or absence of incontinence. Diaries indicated a decrease in both daytime and nighttime voiding symptoms.

Maximal efficacy occurred between 7 and 30 days and lasted for at least 6 months. Condition-specific quality-of-life symptom scores also demonstrated improvement.

No long-term complications had occurred at last follow-up.

Two women with Multiple Sclerosis and mild baseline Stress Urinary Incontinence reported increased leakage with stress after BTX-A External Sphincter injection, and one woman with Multiple Sclerosis noted new onset stress urinary incontinence after External Sphincter injection.

However, they all reported significant improvement in their Detrusor Sphincter DysSynergia with decreased postvoid residual urine volume, improved uroflow, decreased urge incontinence, and decreased daytime and nighttime frequency.

One woman with Multiple Sclerosis who underwent Bladder injection had increased postvoid residual urine volume from 78 to 155 mL. She did not have to perform intermittent catheterization.

BTX-A injection is a safe and promising treatment modality for a variety of Lower Urinary Tract Dysfunctions for both skeletal and smooth muscle dysfunction.

In our series, BTX-A is equally effective in women as it is in men. When injected into the Sphincter, the risk of stress incontinence is low.

Bladder injections with BTX-A are effective for not only Neurogenic Detrusor overactivity, but also overactive Bladder. BTX-A can even be considered for Interstitial Cystitis.


Relationship Of Bladder Dysfunction To Lesion Site In Multiple Sclerosis

Araki I, Matsui M, Ozawa K, Takeda M, Kuno S
J Urol 2003 Apr;169(4):1384-7
Utano National Hospital, Department of Urology, Kyoto, Japan
PMID# 12629367

We investigated the relationship of Voiding Dysfunction type and the lesion site in patients with Multiple Sclerosis.

Materials And Methods
Voiding Dysfunction was evaluated in 32 patients with Multiple Sclerosis using the International Prostate Symptom Score and Urodynamic tests.

Lesion sites were determined by combined Neurological Examination and Magnetic Resonance Imaging findings.

Compared with reports from Western countries the ratio of emptying-to-filling symptoms was high in Japan. Of Urinary symptoms only filling correlated with disability status and disease duration.

Urinary symptoms were not related to lesion sites. Urodynamic evaluation revealed Detrusor Hyperreflexia in 14 of 32 patients, HypoReflexia or Areflexia in 12, Detrusor HyperReflexia with impaired contractile function in 4, a low compliance Bladder in 1 and normal function in 1.

Of 14 patients with HyperReflexia 13 had overactive Sphincter concurrently. Incompetent Sphincter was identified in 2 patients who had Detrusor HyperReflexia with impaired contractility and in 1 with a low compliance Bladder.

A significant correlation was noted for a Pontine lesion and Detrusor HypoReflexia, and for a Cervical Cord lesion and Detrusor-Sphincter DysSynergia.

Detrusor HypoReflexia and Detrusor-Sphincter DysSynergia are indicative of a Pontine and Cervical Spinal Cord lesion, respectively.

Thus, the lesion site in the Central Nervous System may be a major determinant of the type of Bladder and Urethral Sphincter Dysfunction.

The high prevalence of emptying symptoms in Japanese patients may reflect the prevalence of Detrusor HypoReflexia and Detrusor-Sphincter DysSynergia.


VesicoUrethral Dysfunction Associated With Multiple Sclerosis: Clinical And Urodynamic Perspectives

Barbalias GA, Nikiforidis G, Liatsikos EN
J Urol 1998 Jul;160(1):106-11
University of Patras, School of Medicine, Department of Urology, Greece
PMID# 9628615

We investigate the association of clinical and Urodynamic findings with corresponding clinical grade and possible predictors of clinical grade of Multiple Sclerosis (MS).

Materials And Methods
A total of 90 patients, 28 to 62 years old (mean age 45.8 +/- 12.1), with the clinical syndrome of MS were consecutively and prospectively studied.

All patients were subjected to detailed video urodynamic evaluation and electromyography of the external urethral sphincter.

Urodynamic evaluation revealed detrusor HyperReflexia in 52 patients (57.7%), Detrusor External Sphincter DysSynergia in 27 (30%) and HypoContractility or areflexia of the Detrusor in 15 (16.6%).

Residual urine varied widely from 50 to 900 ml. Decreased compliance with areflexia was seen in 5 patients (5.5%) and nonrelaxing sphincter (but not contracting) with Bladder HyperContractility was noted in 9 (10%).

Statistical analysis followed comparison of 2 proportions.

When patients with a less severe form (grades 1 and 2) were differentiated from those with a more severe form of MS (grade 3), we observed a significant difference only in incontinence, high post-void residual, leg spasticity, urinary stones, hydronephrosis, type 3 Detrusor External Sphincter DysSynergia, no electromyography activity and positive sharp waves.

The variables with the highest predictive value between the groups were urinary stones, sepsis, type 3 Detrusor External Sphincter DysSynergia and no electromyography activity of the External Urethral Sphincter (100%).

Proper identification of the bladder and External Urethral Sphincter status, especially exclusion of Detrusor overactivity or a DysSynergic response of the External Urethral sphincter, will prevent complications that may result in deterioration of quality of life.

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