Consensus document on the multidisciplinary management of neurogenic lower urinary tract dysfunction in patients with multiple sclerosis

Neurourol Urodyn. 2020 Feb;39(2):762-770. doi: 10.1002/nau.24276. Epub 2020 Jan 15.


Aim: Neurogenic lower urinary tract dysfunction (NLUTD) is very common in multiple sclerosis (MS) patients. Early diagnosis and treatment are crucial to avoid irreversible damage and improve quality of life. Our aim was to develop recommendations to improve NLUTD identification in MS patients, along with their referral and management.

Methods: A multidisciplinary group of 14 experts in the management of patients with MS and NLUTD (nine urologists, three neurologists, and two rehabilitators) was selected. A comprehensive review of the literature was undertaken and a set of recommendations was generated and submitted to a Delphi panel of 114 experts. Recommendations were presented according to the grade of agreement (GA).

Results: Early diagnosis in asymptomatic patients with risk factors for complications is recommended (GA 94%). Postvoid residual volume should be measured if changes in urinary symptoms (GA 87%), preferably ultrasound-guided (GA 86%). Early referral to urologist is recommended if urinary incontinence (GA 91%), significant post-void residual volume (94%), quality of life impairment (GA 98%) and recurrent urinary infections (GA 97%). The initial evaluation should include physical examination (GA 99%) and urodynamics including cystometry (GA 89%), pressure-flow study (90%) and electromyography (GA 70%). The panel recommends multidisciplinary collaboration (GA 100%) with a rehabilitation specialist and trained nurses in the management of NLUTD (GA 99%).

Conclusions: Multidisciplinary management for patients with NLUTD due to MS is advised, including urologists, neurologists, rehabilitation, and nurses. Panel recommends early diagnosis with post-void residual volume in symptomatic patients before referring to urologist and urodynamics when referred.

Keywords: consensus; multidisciplinary care; multiple sclerosis; neurogenic lower urinary tract dysfunction.

Publication types

  • Consensus Development Conference
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Consensus
  • Delphi Technique
  • Disease Management
  • Disease Progression
  • Humans
  • Lower Urinary Tract Symptoms / etiology
  • Lower Urinary Tract Symptoms / physiopathology
  • Lower Urinary Tract Symptoms / therapy*
  • Multiple Sclerosis / complications
  • Multiple Sclerosis / therapy*
  • Neurology
  • Patient Care Team
  • Quality of Life
  • Referral and Consultation
  • Risk Factors
  • Urinary Bladder, Neurogenic / etiology
  • Urinary Bladder, Neurogenic / physiopathology
  • Urinary Bladder, Neurogenic / therapy*
  • Urinary Incontinence / etiology
  • Urinary Incontinence / physiopathology
  • Urinary Incontinence / therapy
  • Urinary Tract Infections / etiology
  • Urinary Tract Infections / physiopathology
  • Urinary Tract Infections / therapy
  • Urodynamics
  • Urologic Surgical Procedures
  • Urology