Non-pharmacologic options for the management of voiding dysfunction in multiple sclerosis

Multiple sclerosis is a neuroinflammatory condition that can cause significant bladder dysfunction manifesting either as overactive bladder or impaired bladder emptying.Patients will often complain of urgency,frequency,nocturia,urgency incontinence,hesitancy,straining to void,and incomplete bladder emptying.While these symptoms can be treated with pharmacologic agents,often patients will require more significant treatments.Patients should first be evaluated with urodynamics in order to adequately diagnose the pathologic condition causing their symptoms.These interventions include catheter use,injection of botulinum toxin,neuromodulation,urethral stenting,sphincterotomy,suprapubic catheter with bladder neck closure,bladder augmentation and urinary diversion.The purpose of this review is to examine the evidence supporting each of these treatment options so urologic providers can better provide for this unique and complex patient population.