58 - Management of bladder and sexual dysfunction in multiple sclerosis

Summary

Many multiple sclerosis (MS) patients have symptoms of lower urinary tract (bladder and urethral) dysfunction (LUTD) or sexual dysfunction early in their course. Symptoms of LUTD in MS include frequency, urgency, incontinence, hesitancy, and urinary retention. The history of having MS itself should raise the issue of urological dysfunction, particularly in view of the often asymptomatic nature of voiding dysfunction. The general physical exam may be of assistance in the assessment for urological dysfunction. In low-risk patients (those without indwelling catheters or detrusor sphincter dyssynergia), there is a low incidence of renal complications and upper tract deterioration, supporting a conservative approach to upper tract management. Imaging studies have correlated sexual dysfunction with parietal lesions, increased lateral ventricle size, and total lesion burden. Vibratory stimulation may enhance erections, and may be used to decrease the orgasmic threshold for both men and women.