Management of Urinary Symptoms in Multiple Sclerosis: An Umbrella Review

BACKGROUND: Lower urinary tract dysfunctions (LUTDs) are prevalent among patients with multiple sclerosis (MS), which is the most common immune-mediated neurologic disease among the juvenile population. This study aims to evaluate the efficacy and safety of different methods in the management of MS-related LUTD. METHODS: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Joanna Briggs Institute (JBI) methods. Systematic review studies that reported the efficacy of any management method for LUTD in MS are considered for inclusion. A systematic search was conducted in PubMed, Scopus, Embase, and Web of Science and risk of bias was assessed using the JBI critical appraisal checklist for systematic reviews. RESULTS: Out of 342 screened records, 34 systematic reviews were included. Preliminary efficacy and safety of pelvic floor muscle training (PFMT) and tibial nerve stimulation (TNS), as well as the potential of alpha-blockers, cannabinoids, mirabegron, spinal cord stimulation, sacral neuromodulation, transcranial neuromodulations, vaginal/rectal and clitoral/penile stimulation, foot reflexology, craniosacral therapy, and stem cell therapy were suggested. Despite the appropriate efficacy, anticholinergics, desmopressin, intradetrusor injections of botulinum toxin A, vanilloids, and catheterization were found to cause considerable side effects. DISCUSSION: Despite a high prevalence of LUTDs in MS patients, evidence basis of the management methods is still poor and there is lack of well-designed randomized controlled trials, which makes evidence inconclusive. Future research is needed to refine treatment algorithms, investigate the potential of combination therapies, and develop individualized treatment paradigms.