Management of Urinary Urgency in Men with Multiple Sclerosis

Initial Assessment

The American Urological Association recommends performing a thorough bladder function assessment, including measurement of urinary frequency, volume, control, and assessment for dysuria, in men with multiple sclerosis 3
The American Urological Association suggests evaluating post-void residual volume using bladder scanner or in-and-out catheterization to determine the degree of urinary retention in men with multiple sclerosis 3
Urodynamic testing should be considered if empiric anticholinergic therapy is planned, as symptoms alone do not reliably predict obstructive findings in men with neurological conditions, according to the American Urological Association 3, 1

The American Urological Association recommends anticholinergic medications as first-line pharmacological treatment for storage symptoms in neurogenic lower urinary tract dysfunction (NLUTD) 1
Beta-3 adrenergic receptor agonists, such as mirabegron, may be used alone or in combination with anticholinergics to improve bladder storage parameters, as suggested by the European Association of Urology 1
The European Association of Urology recommends combination of alpha-1 blockers with antimuscarinic agents for men with both storage and voiding symptoms 4
Monitoring of post-void residual (PVR) volume is recommended during treatment with anticholinergics, according to the European Association of Urology 4
Antimuscarinic medications should be avoided in men with PVR volume >150 ml, as advised by the European Association of Urology 4

The British Association of Urological Surgeons recommends intermittent catheterization as the gold standard for treating voiding disorders associated with neurogenic bladder 2, 1
Clean intermittent catheterization should be implemented on a regular schedule (every 4-6 hours) to keep urine volume below 500 ml per collection, as suggested by the British Association of Urological Surgeons 2
Hydrophilic catheters are recommended, as they are associated with fewer urinary tract infections and less hematuria, according to the British Association of Urological Surgeons 2
Indwelling catheters should be avoided due to higher risk of urinary tract infections, bladder stones, and poorer quality of life, as advised by the American Urological Association 1

A comprehensive bladder management program should be implemented to enable regular emptying while preventing leakage and maintaining low bladder pressures, as recommended by the British Association of Urological Surgeons 2
Proper hand hygiene (using antibacterial soap or alcohol-based cleaners) should be taught before and after catheter insertion, according to the British Association of Urological Surgeons 2
Adequate fluid intake should be ensured, but excessive fluid consumption that may worsen urgency should be avoided, as suggested by the British Association of Urological Surgeons 2

Asymptomatic bacteriuria should not be treated with antibiotics in MS patients with neurogenic bladder, as recommended by the British Association of Urological Surgeons 5
Urine dipstick testing alone is not sufficient for diagnosis of UTI; symptoms must be present to warrant antibiotic treatment, according to the British Association of Urological Surgeons 5
Cranberry products, methenamine salts, and urinary acidification/alkalinization agents have not shown effectiveness in preventing UTIs in patients with neurogenic bladder, as reported by the British Association of Urological Surgeons 2, 5