Vesicourethral dysfunction in multiple sclerosis. Initial assessment based on lower urinary tract symptoms and their pathophysiology.

The most common lower urinary tract symptoms (LUTS) in multiple sclerosis (MS) are irritative, obstructive or mixed (association of irritative and obstructive LUTS). Generally irritative LUTS are typical in patients with cortical, brainstem or mild spinal cord lesions; obstructive symptoms are frequent in patients with spinal cord lesions (below the pontine micturition centre) or at the level of the sacral micturition centre. Irritative LUTS are often associated with detrusor overactivity, whereas obstructive LUTS are associated with detrusor sphincter dyssynergia or detrusor areflexia/hypocontractility. Proper management of these LUTS often could be planned without specialised assessment, in accordance with the algorithms proposed by International Consultation on Incontinence.