MS is a leading cause of LUT dysfunction in neurological i patients and LUT symptoms are reported in an average 8 yrs after the diagnosis of MS. LUT dysfunction is simply and traditionally ...divided into Storage failure , emptying failure and combination of these two. Today ICS classification is based on UDS characteristics measured for both storage and emptying phases. The management of LUT dysfunction is highly personalized and focuses, primarily, on the improvement of patients’ symptoms and QoL and secondarily, on the preservation of the upper urinary tract and avoidance of urological complications (e.g., urinary tract infections, bladder stones, and renal impairment . First-line treatments include fluid management, pelvic floor muscle training (PFMT), and medical therapies (e.g., antimuscarinic agents alone or in combination with B3 receptor agonists ). second-line treatments include BTX-A injections, intravesical therapies, invasive and non-invasive neuromodulation, and catheterization. Surgery may be indicated in select cases. First-line management can be initiated in neurological practice, but early referral to a urology service should be considered in certain situations, specially if red flags are present.
•A group of Iranian neurologists with experience in the field of MS gathered to develop a practical consensus in diagnosis and management of PPMS.•In this consensus recommendation, the authors try to ...review how to diagnose PPMS correctly and give answers to important questions in this field in order to define a uniform treatment strategy.•This consensus recommendation is the conclusion of a discussion among expert clinician neurologists, who are involved in this field.
