Moussa Mohamad, Abou Chakra Mohamad, Papatsoris Athanasios G, Dabboucy Baraa, Hsieh Michael, Dellis Athanasios, Fares Youssef
Chairman of Urology Department, Lebanese University & Al Zahraa Hospital, University Medical Center, Beirut, Lebanon.
Urology Department, Lebanese University, Beirut, Lebanon.
Intractable Rare Dis Res. 2021 May;10(2):62-74. doi: 10.5582/irdr.2021.01029.
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. Lower urinary tract dysfunction due to MS includes a dysfunction of the storage phase or dysfunction of the voiding phase or a detrusor-sphincter dyssynergia. Baseline evaluation includes a voiding chart, an ultrasound scan of the urinary tract, urine culture, and an urodynamic study. For storage symptoms, antimuscarinics are the first-line treatment, and clean intermittent catheterization (CIC) is indicated if there is concomitant incomplete bladder emptying. Intradetrusor injections with botulinum toxin A (BTX-A), are recommended for refractory cases. Urinary diversion is rarely indicated. For patients with voiding symptoms, CIC and alpha-blockers are usually offered. Sexual dysfunction in patients with MS is multifactorial. Phosphodiesterase type 5 inhibitors are first-line therapies for MS-associated erectile dysfunction in both male and female patients. This review summarizes the epidemiology, pathogenesis, risk factors, genetic, clinical manifestations, diagnostic tests, and management of MS. Lastly, the urologic outcomes and therapies are reviewed.
多发性硬化症（MS）是一种中枢神经系统的慢性自身免疫性疾病。MS导致的下尿路功能障碍包括储尿期功能障碍、排尿期功能障碍或逼尿肌-括约肌协同失调。基线评估包括排尿图表、泌尿系统超声检查、尿培养和尿动力学研究。对于储尿症状，抗毒蕈碱药物是一线治疗方法，如果同时存在膀胱排空不全，则需进行清洁间歇性导尿（CIC）。对于难治性病例，建议使用肉毒杆菌毒素A（BTX-A）进行膀胱逼尿肌注射。很少需要进行尿流改道。对于有排尿症状的患者，通常采用CIC和α受体阻滞剂治疗。MS患者的性功能障碍是多因素的。5型磷酸二酯酶抑制剂是男性和女性MS相关性勃起功能障碍的一线治疗药物。本综述总结了MS的流行病学、发病机制、危险因素、遗传学、临床表现、诊断测试和管理。最后，对泌尿外科的治疗结果和治疗方法进行了综述。
