Review of neurogenic bladder in multiple sclerosis.

Neurologic involvement of the urinary bladder and urethral sphincter in multiple sclerosis has been known for some time. Thirty-one patients with a proved diagnosis of multiple sclerosis were evaluated urologically for symptoms of urinary incontinence, retention, or urinary tract infection. On initial presentation, 27 (74 per cent) were found to have neurogenic bladders of which 23 (85 per cent) were of the uninhibited type. Electromyography of the periurethral striated muscle revealed vesicosphincter incoordination in 9 of the 19 patients studied. Approximately one-half of the patients with uninhibited bladders had uncoordinated sphincters. Modalities of treatment are discussed.

Association of urinary tract infection and reflux with uninhibited bladder contractions and voluntary sphincteric obstruction.

We studied 53 neurologically normal children with recurrent urinary tract infection who were found to have bladder-sphincter incoordination characterized by voluntary sphincteric constriction during involuntary uninhibited bladder contraction. Increased intravesical pressure was documented during these events and was associated with vesicoureteral reflux in nearly 50 per cent of the children and with abnormalities of the ureteral orifice in 30 per cent of those without reflux. We hypothesize that increased intravesical pressure causes urinary infection in these children and produces a spectrum of intravesical anatomic distortion that predisposes to vesicoureteral reflux. In a prospective uncontrolled study treatment of the uninhibited bladder contractions allowed 58 per cent of the patients to maintain sterile urine without subsequent antimicrobial therapy after cure of the initial infection.