Chronic Urinary Retention in Multiple Sclerosis Patients: Physiology, Systematic Review of Urodynamic Data, and Recommendations for Care.

Many multiple sclerosis (MS) patients are affected by urinary retention. Common causes include neurogenic underactive bladder and/or bladder outlet obstruction from detrusor sphincter dyssynergia. Systemic review of contemporary MS urodynamic studies demonstrates that 53% of MS patients have detrusor overactivity, 43% have detrusor sphincter dyssynergia, and 12% have atonic bladder (12 studies, 1524 patients). There is no standard definition of MS-related urinary retention, but greater than 300 mL is a proposed threshold value for the condition based on literature review. Treatment should be based on stratifying patients by risk from morbidity from retention and by symptoms caused by retention.