Introduction

Multiple sclerosis (MS) is often associated with urological disorders, mainly urinary incontinence and retention, the management of which being necessary to improve patient's quality of life (QOL) and to reduce potential urological complications. Besides the classical treatments based mainly on anticholinergics and/or self-catheterization, several neuromodulation techniques have been tried in recent years to improve these urinary disorders. By this review, we aim at providing an overview of neuromodulation and electrostimulation approaches to manage urinary symptoms in MS patients.

Materials and Methods

A literature search using MEDLINE was performed. Only papers in English, and describing the effects of neuromodulation in MS patients, were considered.

Results

A total of 18 studies met inclusion criteria and were reviewed. Of them, four related to sacral neuromodulation (SNM), seven to percutaneous tibial nerve stimulation (PTNS), six to spinal cord stimulation (SCS), and one to transcranial magnetic stimulation (TMS).

Discussion

PTNS and SNM seem to be effective and safe therapeutic options for treating lower urinary tract symptoms in MS patients principally in case of overactive bladder (OAB) symptoms. Similarly, also SCS and TMS have been shown to be effective, despite the very limited number of patients and the small number of studies found in the literature. Interestingly, these techniques are effective even in patients who do not respond well to conservative therapies, such as anticholinergics. Furthermore, given their safety and efficacy, stimulations such as PTNS could be considered as a first-line treatment for OAB in MS patients, also considering that they are often preferred by patients to other commonly used treatments.

中文翻译：

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皮质、脊髓、骶骨和外周神经调节作为治疗多发性硬化症患者下尿路症状的治疗方法：综述

介绍

多发性硬化症 (MS) 通常与泌尿系统疾病相关，主要是尿失禁和尿潴留，对其进行管理对于改善患者的生活质量 (QOL) 和减少潜在的泌尿系统并发症是必要的。除了主要基于抗胆碱能药物和/或自行导尿的经典治疗外，近年来还尝试了几种神经调节技术来改善这些泌尿系统疾病。通过这篇综述，我们旨在提供神经调节和电刺激方法的概述，以管理 MS 患者的泌尿系统症状。

材料和方法

使用 MEDLINE 进行了文献检索。只考虑了英文论文，并描述了神经调节对 MS 患者的影响。

结果

共有 18 项研究符合纳入标准并进行了审查。其中，4 项与骶神经调节 (SNM) 相关，7 项与经皮胫神经刺激 (PTNS) 相关，6 项与脊髓刺激 (SCS) 相关，1 项与经颅磁刺激 (TMS) 相关。

讨论

PTNS 和 SNM 似乎是治疗 MS 患者下尿路症状的有效且安全的治疗选择，主要是在出现膀胱过度活动症 (OAB) 症状的情况下。同样，SCS 和 TMS 也被证明是有效的，尽管患者数量非常有限且文献中的研究数量很少。有趣的是，这些技术甚至对抗胆碱能药物等保守疗法反应不佳的患者也有效。此外，考虑到它们的安全性和有效性，PTNS 等刺激可被视为 MS 患者 OAB 的一线治疗，同时考虑到患者通常更喜欢其他常用治疗。