Konstantinos-Vaios Mytilekas

Degenerative Diseases (Multiple Sclerosis, Parkinson’s Disease)

Lower urinary tract symptoms (LUTS) and incontinence are highly prevalent among multiple sclerosis (MS ) patients and are strongly related to the duration, progress and severity of the neurological condition. Mixed LUTS are common, with a higher prevalence of detrusor overactivity (DO) in urodynamic investigations. Interestingly, upper urinary tract damage is infrequent in MS patients. Despite the negative effect on QoL, the majority of MS patients do not consult a urologist. Available treatments are similar as in non-neurogenic LUTS, albeit with a lower level of evidence apart from intradetrusor injections of botulinum neurotoxin A. Lifestyle interventions with or without antimuscarinics and clean intermittent catheterizations are the mainstay of management, but with significant rates of discontinuation. Invasive surgery (enterocystoplasty, urinary diversion procedures) is spared for refractory cases and those patients with upper extremity dexterity issues.