Urologic manifestations of multiple sclerosis: proposed treatment algorithms.

PURPOSE: A detailed clinical management of the urological manifestations of multiple sclerosis (MS) is presented as it is practiced in our department, and therapeutic algorithms are constructed. MATERIALS AND METHODS: One hundred and ten patients were consecutively and prospectively studied with a clinical syndrome of MS. ranging in age from 32 to 65 years of age. Clinical diagnosis of the voiding dysfunction associated with MS was classified as a malfunction causing either problems of bladder evacuation, or storage, or a combination of both. RESULTS: All patients were initially managed in a conservative way avoiding surgical procedures and following primarily pharmacologic treatment, because of the quite common reversibility of MS. The detailed management of the related voiding dysfunction is given by the proposed algorithms. CONCLUSIONS: Our purpose was to present the algorithms that can help the practicing physician to come to reasonable conclusions as to therapeutical choices directed to specific pathophysiologic characteristics of voiding dysfunction related to MS.

Vesicourethral dysfunction associated with multiple sclerosis: correlations among response, most prevailing clinical status and grade of the disease.

PURPOSE: In the present study we have performed a correlation of the most prevailing clinical conditions of multiple sclerosis (MS) with overall drug response and the grade of the disease. MATERIALS AND METHODS: One hundred and ten patients were consecutively and prospectively studied with a clinical syndrome of MS, ranging in age from 32 to 65 years of age. In the present study we evaluated the patients with DESD (n = 35), detrusor hyperreflexia (n = 32), and/or low compliance (n = 8). The latter three conditions were considered as the most threatening, and thus a correlation with the drug response and the grade of the disease was attempted. RESULTS: All patients were initially managed in a conservative way avoiding surgical procedures and following primarily pharmacologic treatment, because of the quite common reversibility of MS. Our results suggest that there is no correlation between the prevailing clinical status and drug response (p = 0.06) or grade of the disease (p = 0.07). The only statistically significant correlation was seen between grade of the disease and overall drug response (p < 0.0001) CONCLUSIONS: Therapeutic responses were dependent upon the grade of the disease. The continuation of this study recruiting more patients into various subgroups of voiding dysfunction will further validate the statistical correlations among disease grade and therapeutic responses.

Clinical management of the neurourological syndrome associated with multiple sclerosis and correlations to grade of the disease.

PURPOSE: In this study a detailed clinical management is presented as it is practiced in our department, and possible correlations between grade of the disease and therapeutic responses are examined. MATERIALS AND METHODS: One hundred and ten patients were consecutively and prospectively studied with a clinical syndrome of MS, ranging in age from 32 to 65 years of age. Clinical diagnosis of the voiding dysfunction associated with MS was classified as a malfunction causing either problems of bladder evacuation, or storage, or a combination of both. Therapeutic responses of the voiding dysfunction were correlated with grade of the disease. Mean follow up period was 54 months. RESULTS: All patients were initially managed in a conservative way avoiding surgical procedures and following primarily pharmacologic treatment, because of the quite common reversibility of MS. A possible correlation of response to treatment according to grade of the disease was studied. There was significant difference in the response to drug treatment among patients of different grades favoring grade 1 patients with both storage and evacuation voiding dysfunction. CONCLUSIONS: Our suggested treatment has secured the conversion of a high pressure into a low pressure vesicourethral system, thus obviating possible risk factors for the upper urinary tract and the bladder itself. Therapeutic responses were dependent upon the grade of the disease.

Metal stents for the management of atherosclerotic renovascular disease.

PURPOSE: We report on our experience with the use of metal stents for the treatment of atherosclerotic renovascular disease. PATIENTS AND METHODS: Since 1996, 62 patients (mean age 67 years) with ostial atherosclerotic renal artery stenosis were treated successfully by placement of metal stents. All patients presented with renovascular hypertension, and eight had additionally impaired renal function. In 12 patients, stents were placed bilaterally. In 54 patients, the introduction of stents was performed as the primary mode of treatment, and in the remaining 8 patients, the positioning of the endoprosthesis was deemed necessary because of recurrence of stenosis previously treated by renal percutaneous transluminal angioplasty (PTA). The patients were followed for a mean period of 18 months (range 9-48 months). RESULTS: Positioning of the endoprosthesis was successful in all patients. No major complications were reported. The 18-month patency rate was 77.4% (48 patients). Hypertension resolved in 39 patients and showed a trend to improvement in 15 patients. We observed no improvement of renal function in the eight patients who had impaired function prior to the procedure. CONCLUSION: Implantation of metal stents is a safe and effective method for the treatment of atherosclerotic renal artery stenosis and certainly presents an important alternative to renal PTA.