Les complications urologiques dans la sclérose en plaques: étude des facteurs de risques

Etiology, presentation and management of urinary tract infections in multiple sclerosis patients: A review of the current literature

Urinary tract infections (UTIs) present a formidable challenge in the care of individuals affected by multiple sclerosis (MS). Lower urinary tract dysfunction is a prevalent issue among MS patients, predisposing them to an elevated risk of UTIs. When left untreated, UTIs can further exacerbate the already compromised quality of life in individuals with MS. The diagnosis and management of UTIs in MS patients necessitate a careful clinical evaluation. The objective of this review is to delineate preventive strategies and current and developing therapeutic approaches for preventing and treating UTIs associated with urinary dysfunction, catheterization, and upper urinary tract infections in patients with MS. Effectively addressing UTIs and urinary tract dysfunction in individuals with multiple sclerosis calls for a comprehensive, interdisciplinary approach.

Physical training and multiple sclerosis

For many years, patients with multiple sclerosis (MS) were advised to avoid exercise because of the risk of increased neurological impairment. This article reviews the literature related to MS and physical exercise. Physical exercise depends on patients' physiological tolerance and response to exercise. MS patients can exhibit dysfunction of cardiovascular adjustment accompanied by respiratory involvement, which can alter aerobic capacity. These abnormalities tend to increase with the neurological impairment. Muscle weakness is the consequence of not only altered central motor drive but also disuse. Several studies have shown the benefits of physical training, with improvements in aerobic capacity, gait parameters and fatigue, and an influence on quality of life. Regular aerobic physical activity is necessary to maintain the benefit of physical training.

The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines

Vesicourethral dysfunction is very frequent in multiple sclerosis (MS) and has functional consequences for patients' quality of life and also an organic impact following complications of the neurogenic bladder on the upper urinary tract. While the functional impact and its management are well documented in the literature, the organic impact remains underestimated and there are no consensual practical guidelines for the screening and prevention of MS neurogenic bladder complications. The aim of this review of the literature, focused on identifying the risk factors of urinary tract complications in MS, is to put forward well informed considerations to help in the definition of practical guidelines for the follow-up of the neurogenic bladder in MS in order to improve its prevention and patient management. Four main risk factors have been identified for upper urinary tract damage: the duration of MS, the presence of an indwelling catheter, high-amplitude neurogenic detrusor contractions and permanent high detrusor pressure. Detrusor-sphincter dyssynergia, age over 50 and male sex may form three additional risk factors. Recommendations for long-term urological follow-up, taking into account these specific risks are constructed according to the procedures recommended by the French Health Authorities.

[Detrusor-sphincter dyssynergia: four case reports and literature review]

Detrusor-sphincter dyssynergia is responsible for major impairment and is factor for social and professional activity repercussions.

METHODS

We have studied the clinical and urodynamic finding in four patients (two men and two women) with detrusor-sphincter dyssynergia. Mean age is 36 years (26-44 years). Dyssynergia was secondary to tuberculosis meningitis in one case, surgery for rectal adenocarcinoma in one case, tight vertebral canal in one case and in one case the cause is indeterminate. The detrusor-sphincter dyssynergia were treated by autocatheterism in two cases, antibiotherapy antituberculosis associated with an anticholinergic drugs in one case and by alpha-blockers agent in another.

RESULTS

Quasi-complete salvage of the motor deficit and the dysfonctional voiding in a patient treated by antibiotherapy antituberculosis associated with an anticholinergic drugs. As well, maid evolution in patient treated by alpha-blockers agent and who practice self catheterization.

CONCLUSION

Optimal treatment is unknown, and the existence of several cures indicated the limit of all therapeutic methods.