https://uroweb.org/wp-content/uploads/20_Neurogenic-LUTD_LR.pdf

EAU Guidelines on Neurogenic Lower Urinary Tract Dysfunction

https://europeanurology.com/article/S0302-2838(15)00740-X/pdf/summary-of-european-association-of-urology-eau-guidelines-on-neuro-urology

Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology

Vesicourethral dysfunction is very frequent in multiple sclerosis (MS) and has functional consequences for patients' quality of life and also an organic impact following complications of the neurogenic bladder on the upper urinary tract. While the functional impact and its management are well documented in the literature, the organic impact remains underestimated and there are no consensual practical guidelines for the screening and prevention of MS neurogenic bladder complications. The aim of this review of the literature, focused on identifying the risk factors of urinary tract complications in MS, is to put forward well informed considerations to help in the definition of practical guidelines for the follow-up of the neurogenic bladder in MS in order to improve its prevention and patient management. Four main risk factors have been identified for upper urinary tract damage: the duration of MS, the presence of an indwelling catheter, high-amplitude neurogenic detrusor contractions and permanent high detrusor pressure. Detrusor-sphincter dyssynergia, age over 50 and male sex may form three additional risk factors. Recommendations for long-term urological follow-up, taking into account these specific risks are constructed according to the procedures recommended by the French Health Authorities.

The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines:

Lower urinary tract (LUT) dysfunction is a common sequela of neurological disease, resulting in symptoms that have a pronounced effect on quality of life. The site and nature of the neurological lesion affect the pattern of dysfunction. The risk of developing upper urinary tract damage and renal failure is much lower in patients with slowly progressive non-traumatic neurological disorders than in those with spinal cord injury or spina bifida; this difference in morbidity is taken into account in the development of appropriate management algorithms. Clinical assessment might include tests such as uroflowmetry, post-void residual volume measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the indication. Incomplete bladder emptying is most often managed by intermittent catheterisation, and storage dysfunction by antimuscarinic drugs. Intradetrusor injections of onabotulinumtoxinA have transformed the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. An individualised, patient-tailored approach is required for the management of LUT dysfunction associated with neurological disorders.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(15)00070-8.pdf

Lower urinary tract dysfunction in the neurological patient: clinical assessment and management

Aims
Electrostimulation is an established therapeutic option for neurogenic urinary disorders. The aim of this study was to investigate the efficacy of the noninvasive technique of transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with multiple sclerosis (MS) and troublesome symptoms of an overactive bladder (OAB).

Methods
A multicentric study enrolled 70 MS patients, suffering from OAB for a 3-month study period. Intervention: Daily sessions of 20 min of TPTNS were provided. No change of associated treatments during the study period. The primary outcome measurement was Urgency and Frequency reported by bladder diary and symptom score performed before the treatment (Day 0, D0) and at D30 and D90. The secondary outcomes measurements were continence, symptom score, quality of life, psychosocial burden at DO, D30, and D90 and cystometry at baseline, with and without TPTNS and at D90.

Results
Clinical improvement of OAB was shown in 82.6% and 83.3% of the patients on D30 and D90, respectively, with significant improvement of primary and secondary outcomes compared to baseline. The initial acute cystometric response to TPTNS was positive in 51.2% of the patients (increase of >30% of cystometric capacity and/or reflex volume), without correlation with TPTNS clinical efficiency. The procedure was well tolerated.

Conclusions
Chronic TPTNS appears to be effective in the management of severe OAB in MS, without compromising bladder emptying or inducing side effect. Treatment may be effective even in the absence of an acute cystometric effect. Additional works are required to demonstrate long-term efficacy of TPTNS. Neurourol. Urodynam. 30:306–311, 2011. © 2011 Wiley-Liss, Inc.

Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study.

Development and validation of the short form of a urinary quality of life questionnaire: SF-Qualiveen.

https://www.archives-pmr.org/article/S0003-9993(04)00016-4/pdf

Measuring quality of life in multiple sclerosis patients with urinary disorders using the Qualiveen questionnaire.

Development and psychometric validation of the intermittent self-catheterization questionnaire.

https://www.archives-pmr.org/article/S0003-9993(06)01328-1/pdf

Véronique Bonniaud

Papers

Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study.

Development and validation of the short form of a urinary quality of life questionnaire: SF-Qualiveen.

Measuring quality of life in multiple sclerosis patients with urinary disorders using the Qualiveen questionnaire.

Development and psychometric validation of the intermittent self-catheterization questionnaire.

Qualiveen: A Urinary Disorder−Specific Instrument for Use in Clinical Trials in Multiple Sclerosis