Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Nov 1992
ReviewTreatment of lower urinary tract dysfunction in patients with multiple sclerosis. Committee of the European Study Group of SUDIMS (Sexual and Urological Disorders in Multiple Sclerosis)
Bladder symptoms in patients with multiple sclerosis (MS) are common and usually arise as a result of spinal lesions which interrupt the neural pathways connecting the pontine micturition centre to the sacral spinal cord. Thus these symptoms are particularly likely to occur in those with lower limb neurological deficits. Fortunately bladder dysfunction in MS is rarely associated with serious upper tract disease so that the problem is usually one of symptomatic management. ⋯ Treatment is aimed at minimising both these effects. Oral anticholinergic medication can be effective in reducing detrusor hyperreflexia and intermittent catheterisation is used to reduce abnormally high post micturition residual volumes. With this simple treatment, often used in combination, many less severely affected patients with MS can gain considerable improvement in controlling urinary continence.
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All the medical, surgical and engineering personnel in the UK who have used spinal cord stimulation (SCS) in patients, attended a workshop to discuss their results. The major use of SCS has been for multiple sclerosis and intractable pain. ⋯ Further information on long term benefit is needed and the use of SCS in other conditions, such as spinal injury and peripheral vascular disease, is not yet established. SCS cannot be recommended for use outside large centres as x-ray screening, urodynamic and neurophysiological assessment facilities are required as well as biological engineering assistance.