The changing neurourologic pattern of multiple sclerosis.

The changing clinical course of multiple sclerosis is a hallmark of the disease. The neurourologic findings in this disorder have been well documented in the literature but the occurrence of urodynamic changes with time has been mentioned only briefly. Ten men and 8 women had 2 or more urodynamic evaluations, consisting of cystometrography and perineal floor needle electromyography during 2 months to 6 years (mean 25 months). The initial urodynamic patterns included a normal study in 1 patient, detrusor areflexia in 7 and detrusor hyperreflexia in 10 (5 with vesicosphincter dyssynergia). Re-examinations were done for persistent or new symptoms. The urodynamic pattern changed in 10 patients (55 per cent), including cystometrographic changes in 7, newly developed neuropathic changes on electromyography in 5 and changes in detrusor-sphincter interaction in 9 (with 5 new cases of vesicosphincter dyssynergia). Of the 8 patients who did not demonstrate a urodynamic change 5 had vesicosphincter dyssynergia that persisted on followup. Vesicosphincter dyssynergia was the predominant pattern noted on re-evaluation, acting as a urodynamic indicator of progressive multiple sclerosis. Careful neurourologic assessment should be performed routinely in the followup of multiple sclerosis patients who are unresponsive to treatment or who manifest new symptoms.