Multiple Skleroz
Özet
Multiple skleroz hastalarında alt üriner sistem işlev bozukluğu (AÜSİB), hastalığın en sık görülen ve yaşam kalitesini doğrudan etkileyen sorunlarından biridir. Hastaların yönetiminde ürodinamik değerlendirmeler büyük bir öneme sahip olup tanı ve takip süreçlerinde yol gösterici bir rol oynar. Tedavi yaklaşımı multidisipliner olmalı; konservatif yöntemlerden farmakolojik tedavilere, nöromodülasyon tekniklerinden cerrahi müdahalelere kadar geniş bir çerçevede ele alınmalıdır. Mevcut kılavuzlar MS hastalarına özel bir tedavi algoritması sunmamakla birlikte, genel nörojenik AÜSİB yönetim prensiplerinin büyük ölçüde bu hasta grubu için de geçerli olduğu bilinmelidir. Ancak, MS hastalarında bilişsel ve motor fonksiyon bozukluklarının varlığı, tedavi seçeneklerinin seçimini ve uygulanabilirliğini doğrudan etkileyebileceğinden, her hastaya özel bireyselleştirilmiş bir yaklaşım benimsenmelidir. Bu hastaların düzenli takibi ve tedavi seçeneklerinin özenle uygulanması, yaşam kalitesini artırmada ve muhtemel komplikasyonları önlemede hayati bir rol oynamaktadır.
Referanslar
Phé V, Schneider MP, Peyronnet B, Abo Youssef N, Mordasini L, Chartier‐Kastler E, et al. Desmopressin for treating nocturia in patients with multiple sclerosis: a systematic review: a report from the Neuro‐Urology Promotion Committee of the International Continence Society (ICS). Neurourology and urodynamics. 2019;38(2):563-71.
Wallin MT, Culpepper WJ, Nichols E, Bhutta ZA, Gebrehiwot TT, Hay SI, et al. Global, regional, and national burden of multiple sclerosis 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2019;18(3):269-85.
Öztürk B, Taşkıran E, Demir S, Tuncer MA, Kürtüncü M, Karabudak R, et al. Prevalence and incidence of multiple sclerosis in Turkey: A nationwide epidemiologic study. Multiple Sclerosis Journal. 2024;30(7):790-9.
Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, Wein AJ. Campbell Walsh Wein Urology, E-Book: 3-Volume Set: Elsevier Health Sciences; 2020.
Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sørensen PS, Thompson AJ, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278-86.
Aharony SM, Lam O, Corcos J. Evaluation of lower urinary tract symptoms in multiple sclerosis patients: review of the literature and current guidelines. Canadian urological association journal. 2017;11(1-2):61.
Phe V, Chartier–Kastler E, Panicker JN. Management of neurogenic bladder in patients with multiple sclerosis. Nature Reviews Urology. 2016;13(5):275-88.
Marrie R, Cutter G, Tyry T, Vollmer T, Campagnolo D. Disparities in the management of multiple sclerosis–related bladder symptoms. Neurology. 2007;68(23):1971-8.
Medina‐Polo J, Adot JM, Allué M, Arlandis S, Blasco P, Casanova B, et al. Consensus document on the multidisciplinary management of neurogenic lower urinary tract dysfunction in patients with multiple sclerosis. Neurourology and urodynamics. 2020;39(2):762-70.
Torad H, Shalaby N, Hussein HA, Sadek SZ, Abdelazim MS, Yehia A, et al. Bladder and urodynamic changes in multiple sclerosis. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2020;56:1-6.
Tadayyon F, Etemadifar M, Bzeih H, Zargham M, Nouri-Mahdavi K, Akbari M, et al. Association of urodynamic findings in new onset multiple sclerosis with subsequent occurrence of urinary symptoms and acute episode of disease in females. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences. 2012;17(4):382.
Ciancio SJ, Mutchnik SE, Rivera VM, Boone TB. Urodynamic pattern changes in multiple sclerosis. Urology. 2001;57(2):239-45.
Khavari R, Karmonik C, Shy M, Fletcher S, Boone T. Functional magnetic resonance imaging with concurrent urodynamic testing identifies brain structures involved in micturition cycle in patients with multiple sclerosis. The Journal of urology. 2017;197(2):438-44.
Al Dandan HB, Coote S, McClurg D. Prevalence of lower urinary tract symptoms in people with multiple sclerosis: a systematic review and meta-analysis. International journal of MS care. 2020;22(2):91-9.
Browne C, Salmon N, Kehoe M. Bladder dysfunction and quality of life for people with multiple sclerosis. Disability and rehabilitation. 2015;37(25):2350-8.
de Medeiros Junior WLG, Demore CC, Mazaro LP, de Souza MFN, Parolin LF, Melo LH, et al. Urinary tract infection in patients with multiple sclerosis: an overview. Multiple Sclerosis and Related Disorders. 2020;46:102462.
Andretta E, Finazzi Agrò E, Calabrese M, Orecchia L, Furlan A, Zuliani C. Antimuscarinics for neurogenic overactive bladder in multiple sclerosis: real-life data. Ther Adv Urol. 2022;14:17562872221122484.
Tijnagel MJ, Scheepe JR, Blok BF. Real life persistence rate with antimuscarinic treatment in patients with idiopathic or neurogenic overactive bladder: a prospective cohort study with solifenacin. BMC urology. 2017;17:1-5.
Ginsberg DA, Boone TB, Cameron AP, Gousse A, Kaufman MR, Keays E, et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation. The Journal of Urology. 2021;206(5):1097-105.
Litwiller SE, FROHMAN EM, Zimmern PE. Multiple sclerosis and the urologist. The Journal of urology. 1999;161(3):743-57.
Çetinel B, Tarcan T, Demirkesen O, Özyurt C, Şen İ, Erdoğan S, et al. Management of lower urinary tract dysfunction in multiple sclerosis: a systematic review and Turkish consensus report. Neurourology and urodynamics. 2013;32(8):1047-57.
Jaekel AK, Winterhagen FI, Zeller FL, Butscher A-L, Knappe FK, Schmitz F, et al. Neurogenic lower urinary tract dysfunction in asymptomatic patients with multiple sclerosis. Biomedicines. 2022;10(12):3260.
Ineichen BV, Schneider MP, Hlavica M, Hagenbuch N, Linnebank M, Kessler TM. High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis. Multiple Sclerosis Journal. 2018;24(4):529-34.
Tornic J, Panicker JN. The management of lower urinary tract dysfunction in multiple sclerosis. Current neurology and neuroscience reports. 2018;18:1-11.
Kennelly M, Dmochowski R, Ethans K, Karsenty G, Schulte-Baukloh H, Jenkins B, et al. Long-term efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: an interim analysis. Urology. 2013;81(3):491-7.
Yuan H, Cui Y, Wu J, Peng P, Sun X, Gao Z. Efficacy and adverse events associated with use of onabotulinumtoxina for treatment of neurogenic detrusor overactivity: a meta-analysis. International Neurourology Journal. 2017;21(1):53.
Ginsberg D, Gousse A, Keppenne V, Sievert K-D, Thompson C, Lam W, et al. Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. The Journal of urology. 2012;187(6):2131-9.
Delaval S, Dequirez P-L, Hentzen C, Baron M, Mille E, Tariel F, et al. Intravesical injections of botulinum neurotoxin A to treat overactive bladder and/or detrusor overactivity related to multiple sclerosis: 5-Year continuation rate and specific risk factors for discontinuation—A study from the neuro-urology committee of the French Association of Urology. Multiple Sclerosis Journal. 2023;29(8):1024-32.
Cruz F, Herschorn S, Aliotta P, Brin M, Thompson C, Lam W, et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. European urology. 2011;60(4):742-50.
Bottet F, Peyronnet B, Boissier R, Reiss B, Previnaire JG, Manunta A, et al. Switch to Abobotulinum toxin A may be useful in the treatment of neurogenic detrusor overactivity when intradetrusor injections of Onabotulinum toxin A failed. Neurourology and Urodynamics. 2018;37(1):291-7.
Leu R, Stearns GL. Complications of Botox and their management. Current urology reports. 2018;19:1-4.
Chui W, Kealey J, Yao HH, Chan G, Bazo A, Parkinson R, et al. Long‐term follow‐up of intradetrusor botulinum toxin utilisation: A comparison of patients with multiple sclerosis and idiopathic overactive bladder. BJUI compass. 2025;6(1):e479.
Gallien P, Reymann J, Amarenco G, Nicolas B, De Sèze M, Bellissant E. Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients. Journal of Neurology, Neurosurgery & Psychiatry. 2005;76(12):1670-6.
Canbaz Kabay S, Kabay S, Mestan E, Cetiner M, Ayas S, Sevim M, et al. Long term sustained therapeutic effects of percutaneous posterior tibial nerve stimulation treatment of neurogenic overactive bladder in multiple sclerosis patients: 12‐months results. Neurourology and urodynamics. 2017;36(1):104-10.
Minardi D, Muzzonigro G. Sacral neuromodulation in patients with multiple sclerosis. World journal of urology. 2012;30:123-8.
Guitynavard F, Mirmosayyeb O, Razavi ERV, Hosseini M, Hosseinabadi AM, Ghajarzadeh M, et al. Percutaneous posterior tibial nerve stimulation (PTNS) for lower urinary tract symptoms (LUTSs) treatment in patients with multiple sclerosis (MS): A systematic review and meta-analysis. Multiple Sclerosis and Related Disorders. 2022;58:103392.
Engeler DS, Meyer D, Abt D, Müller S, Schmid H-P. Sacral neuromodulation for the treatment of neurogenic lower urinary tract dysfunction caused by multiple sclerosis: a single-centre prospective series. BMC urology. 2015;15:1-6.
Pericolini M, Miget G, Hentzen C, Agrò EF, Chesnel C, Lagnau P, et al. Cortical, spinal, sacral, and peripheral neuromodulations as therapeutic approaches for the treatment of lower urinary tract symptoms in multiple sclerosis patients: A review. Neuromodulation: Technology at the Neural Interface. 2022;25(8):1065-75.
Pinto VBP, de Azevedo MF, de Albuquerque LRT, Gomes CM. Management of Neurogenic Stress Urinary Incontinence: An Updated Review. Current Bladder Dysfunction Reports. 2024:1-11.
Referanslar
Phé V, Schneider MP, Peyronnet B, Abo Youssef N, Mordasini L, Chartier‐Kastler E, et al. Desmopressin for treating nocturia in patients with multiple sclerosis: a systematic review: a report from the Neuro‐Urology Promotion Committee of the International Continence Society (ICS). Neurourology and urodynamics. 2019;38(2):563-71.
Wallin MT, Culpepper WJ, Nichols E, Bhutta ZA, Gebrehiwot TT, Hay SI, et al. Global, regional, and national burden of multiple sclerosis 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2019;18(3):269-85.
Öztürk B, Taşkıran E, Demir S, Tuncer MA, Kürtüncü M, Karabudak R, et al. Prevalence and incidence of multiple sclerosis in Turkey: A nationwide epidemiologic study. Multiple Sclerosis Journal. 2024;30(7):790-9.
Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, Wein AJ. Campbell Walsh Wein Urology, E-Book: 3-Volume Set: Elsevier Health Sciences; 2020.
Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sørensen PS, Thompson AJ, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278-86.
Aharony SM, Lam O, Corcos J. Evaluation of lower urinary tract symptoms in multiple sclerosis patients: review of the literature and current guidelines. Canadian urological association journal. 2017;11(1-2):61.
Phe V, Chartier–Kastler E, Panicker JN. Management of neurogenic bladder in patients with multiple sclerosis. Nature Reviews Urology. 2016;13(5):275-88.
Marrie R, Cutter G, Tyry T, Vollmer T, Campagnolo D. Disparities in the management of multiple sclerosis–related bladder symptoms. Neurology. 2007;68(23):1971-8.
Medina‐Polo J, Adot JM, Allué M, Arlandis S, Blasco P, Casanova B, et al. Consensus document on the multidisciplinary management of neurogenic lower urinary tract dysfunction in patients with multiple sclerosis. Neurourology and urodynamics. 2020;39(2):762-70.
Torad H, Shalaby N, Hussein HA, Sadek SZ, Abdelazim MS, Yehia A, et al. Bladder and urodynamic changes in multiple sclerosis. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2020;56:1-6.
Tadayyon F, Etemadifar M, Bzeih H, Zargham M, Nouri-Mahdavi K, Akbari M, et al. Association of urodynamic findings in new onset multiple sclerosis with subsequent occurrence of urinary symptoms and acute episode of disease in females. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences. 2012;17(4):382.
Ciancio SJ, Mutchnik SE, Rivera VM, Boone TB. Urodynamic pattern changes in multiple sclerosis. Urology. 2001;57(2):239-45.
Khavari R, Karmonik C, Shy M, Fletcher S, Boone T. Functional magnetic resonance imaging with concurrent urodynamic testing identifies brain structures involved in micturition cycle in patients with multiple sclerosis. The Journal of urology. 2017;197(2):438-44.
Al Dandan HB, Coote S, McClurg D. Prevalence of lower urinary tract symptoms in people with multiple sclerosis: a systematic review and meta-analysis. International journal of MS care. 2020;22(2):91-9.
Browne C, Salmon N, Kehoe M. Bladder dysfunction and quality of life for people with multiple sclerosis. Disability and rehabilitation. 2015;37(25):2350-8.
de Medeiros Junior WLG, Demore CC, Mazaro LP, de Souza MFN, Parolin LF, Melo LH, et al. Urinary tract infection in patients with multiple sclerosis: an overview. Multiple Sclerosis and Related Disorders. 2020;46:102462.
Andretta E, Finazzi Agrò E, Calabrese M, Orecchia L, Furlan A, Zuliani C. Antimuscarinics for neurogenic overactive bladder in multiple sclerosis: real-life data. Ther Adv Urol. 2022;14:17562872221122484.
Tijnagel MJ, Scheepe JR, Blok BF. Real life persistence rate with antimuscarinic treatment in patients with idiopathic or neurogenic overactive bladder: a prospective cohort study with solifenacin. BMC urology. 2017;17:1-5.
Ginsberg DA, Boone TB, Cameron AP, Gousse A, Kaufman MR, Keays E, et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation. The Journal of Urology. 2021;206(5):1097-105.
Litwiller SE, FROHMAN EM, Zimmern PE. Multiple sclerosis and the urologist. The Journal of urology. 1999;161(3):743-57.
Çetinel B, Tarcan T, Demirkesen O, Özyurt C, Şen İ, Erdoğan S, et al. Management of lower urinary tract dysfunction in multiple sclerosis: a systematic review and Turkish consensus report. Neurourology and urodynamics. 2013;32(8):1047-57.
Jaekel AK, Winterhagen FI, Zeller FL, Butscher A-L, Knappe FK, Schmitz F, et al. Neurogenic lower urinary tract dysfunction in asymptomatic patients with multiple sclerosis. Biomedicines. 2022;10(12):3260.
Ineichen BV, Schneider MP, Hlavica M, Hagenbuch N, Linnebank M, Kessler TM. High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis. Multiple Sclerosis Journal. 2018;24(4):529-34.
Tornic J, Panicker JN. The management of lower urinary tract dysfunction in multiple sclerosis. Current neurology and neuroscience reports. 2018;18:1-11.
Kennelly M, Dmochowski R, Ethans K, Karsenty G, Schulte-Baukloh H, Jenkins B, et al. Long-term efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: an interim analysis. Urology. 2013;81(3):491-7.
Yuan H, Cui Y, Wu J, Peng P, Sun X, Gao Z. Efficacy and adverse events associated with use of onabotulinumtoxina for treatment of neurogenic detrusor overactivity: a meta-analysis. International Neurourology Journal. 2017;21(1):53.
Ginsberg D, Gousse A, Keppenne V, Sievert K-D, Thompson C, Lam W, et al. Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. The Journal of urology. 2012;187(6):2131-9.
Delaval S, Dequirez P-L, Hentzen C, Baron M, Mille E, Tariel F, et al. Intravesical injections of botulinum neurotoxin A to treat overactive bladder and/or detrusor overactivity related to multiple sclerosis: 5-Year continuation rate and specific risk factors for discontinuation—A study from the neuro-urology committee of the French Association of Urology. Multiple Sclerosis Journal. 2023;29(8):1024-32.
Cruz F, Herschorn S, Aliotta P, Brin M, Thompson C, Lam W, et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. European urology. 2011;60(4):742-50.
Bottet F, Peyronnet B, Boissier R, Reiss B, Previnaire JG, Manunta A, et al. Switch to Abobotulinum toxin A may be useful in the treatment of neurogenic detrusor overactivity when intradetrusor injections of Onabotulinum toxin A failed. Neurourology and Urodynamics. 2018;37(1):291-7.
Leu R, Stearns GL. Complications of Botox and their management. Current urology reports. 2018;19:1-4.
Chui W, Kealey J, Yao HH, Chan G, Bazo A, Parkinson R, et al. Long‐term follow‐up of intradetrusor botulinum toxin utilisation: A comparison of patients with multiple sclerosis and idiopathic overactive bladder. BJUI compass. 2025;6(1):e479.
Gallien P, Reymann J, Amarenco G, Nicolas B, De Sèze M, Bellissant E. Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients. Journal of Neurology, Neurosurgery & Psychiatry. 2005;76(12):1670-6.
Canbaz Kabay S, Kabay S, Mestan E, Cetiner M, Ayas S, Sevim M, et al. Long term sustained therapeutic effects of percutaneous posterior tibial nerve stimulation treatment of neurogenic overactive bladder in multiple sclerosis patients: 12‐months results. Neurourology and urodynamics. 2017;36(1):104-10.
Minardi D, Muzzonigro G. Sacral neuromodulation in patients with multiple sclerosis. World journal of urology. 2012;30:123-8.
Guitynavard F, Mirmosayyeb O, Razavi ERV, Hosseini M, Hosseinabadi AM, Ghajarzadeh M, et al. Percutaneous posterior tibial nerve stimulation (PTNS) for lower urinary tract symptoms (LUTSs) treatment in patients with multiple sclerosis (MS): A systematic review and meta-analysis. Multiple Sclerosis and Related Disorders. 2022;58:103392.
Engeler DS, Meyer D, Abt D, Müller S, Schmid H-P. Sacral neuromodulation for the treatment of neurogenic lower urinary tract dysfunction caused by multiple sclerosis: a single-centre prospective series. BMC urology. 2015;15:1-6.
Pericolini M, Miget G, Hentzen C, Agrò EF, Chesnel C, Lagnau P, et al. Cortical, spinal, sacral, and peripheral neuromodulations as therapeutic approaches for the treatment of lower urinary tract symptoms in multiple sclerosis patients: A review. Neuromodulation: Technology at the Neural Interface. 2022;25(8):1065-75.
Pinto VBP, de Azevedo MF, de Albuquerque LRT, Gomes CM. Management of Neurogenic Stress Urinary Incontinence: An Updated Review. Current Bladder Dysfunction Reports. 2024:1-11.
