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Biomedical subjects

T B Boone

Publications and source records attributed to T B Boone.

At least 19 recordsLinked to original sources
PubMed2001

The "bends" and neurogenic bladder dysfunction.

Decompression sickness (the "bends") is a well-known risk of scuba diving. The pathophysiology and treatment is well documented. In the urologic data, no reference to the development of a neurogenic bladder as a result of an episode of the bends was found. We present the evaluation and management of a previously asymptomatic man who developed detrusor hyperreflexia after an episode of decompression sickness. Urologists in coastal communities should be aware of the potential risk of the development of neurogenic bladder.

Decompression Sickness↗
PubMed2001

Urodynamic pattern changes in multiple sclerosis.

OBJECTIVES: Multiple sclerosis (MS) causes neurologic symptoms to change over time. Voiding dysfunction is common in patients with MS, and few studies have examined the changes in urodynamic patterns in these patients over time. The purpose of this study was to examine the frequency and nature of urodynamic pattern changes in patients with MS who underwent two or more urodynamic studies. METHODS: Twenty-two patients (7 men and 15 women) with well-documented MS were referred to one urologist (T.B.B.) for evaluation of lower urinary tract symptoms. All patients had undergone two or more urodynamic evaluations during a 14-year period for persistent or new symptoms, and a retrospective comparison was made among the urodynamic test results. RESULTS: Overall, 12 (55%) of 22 patients experienced a change in their urodynamic patterns and/or compliance during a mean follow-up interval of 42 +/- 45 months between the urodynamic studies. Most patients initially had urodynamic patterns showing detrusor hyperreflexia, detrusor external sphincter dyssynergia, or detrusor hypocontractility. Fourteen (64%) of the 22 patients studied had the same or worsening of the same symptoms and 8 (36%) of 22 had new urologic symptoms. Six (43%) of 14 patients with no new symptoms and 6 (75%) of 8 with new symptoms had significant changes found with follow-up urodynamic testing. CONCLUSIONS: A significant proportion of patients with MS with and without new urinary symptoms will develop changes in their underlying urodynamic patterns and detrusor compliance. Therefore, urodynamic evaluations should be repeated at regular intervals in symptomatic patients to optimize clinical management, reduce complications, and better enable these patients to manage their neurogenic bladder dysfunction.

Adult↗
PubMed2001

Does nocturnal deactivation of the artificial urinary sphincter lessen the risk of urethral atrophy?

OBJECTIVES: To compare nocturnal deactivation with nocturnal activation of the artificial urinary sphincter (AUS) to determine whether nocturnal deactivation reduces the risk of urethral atrophy and subsequent recurrent incontinence. To the best of our knowledge, no review comparing these two approaches has been performed. METHODS: At the Mayo Clinic, all patients are instructed to deactivate their AUS at night; at Baylor, all patients keep their AUS activated all the time. At each institution, a group of consecutive men with comparable severe urinary incontinence after radical retropubic prostatectomy were selected; 61 and 46 patients from the Mayo Clinic and Baylor, respectively, were available for review. All Mayo Clinic patients strictly adhered to nocturnal deactivation of their AUS and all 46 patients from Baylor kept their AUS activated at all times, except during voiding. Each patient was reviewed for the long-term risk of subsequent reoperation, especially regarding recurrent incontinence due to urethral atrophy. RESULTS: Seventeen (27.8%) of the 61 patients from Mayo (mean follow-up 40 months) required a repeated operation. Of the 17 AUS failures, 6 (35%) were due to urethral atrophy. Of the 46 patients from Baylor (mean follow-up 28 months), 16 (34.7%) required a repeated operation. Of the 16 AUS failures, 10 (62%) were due to urethral atrophy. Overall, the patients who nocturnally deactivated their AUS had a 10% risk of atrophy-related incontinence compared with a 21% risk in the nocturnally activated group. CONCLUSIONS: Although not statistically significant, nocturnal deactivation appears to decrease the risk of urethral atrophy and recurrent incontinence (10% versus 21%). Nocturnal deactivation should be considered in men who are dry at night and have sufficient motivation to lessen the risk of urethral atrophy secondary to cuff compression.

Atrophy↗
PubMed2001

Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation.

PURPOSE: Concurrent incontinence and severe recurrent bladder neck contracture following radical prostatectomy are difficult to manage. Recurrent anastomotic strictures following repeat transurethral incisions and resections, and the need for frequent instrumentation are contraindications for artificial urinary sphincter placement. Usually treatment alternatives for these patients consist of some form of urinary diversion or chronic catheter drainage. We evaluated our results using a UroLume stent across the bladder neck contracture followed by placement of an artificial urinary sphincter. MATERIALS AND METHODS: After failed multiple (mean incisions 4.4) attempts at conservative management of anastomotic stricture 9 men were treated with a UroLume urethral stent across the contracture followed by artificial urinary sphincter placement after appropriate epithelialization of the stent was confirmed. RESULTS: All patients were followed for a mean of 17.5 months. Mean pad use per day decreased from 6.5 to 0.7 before and after artificial urinary sphincter placement, respectively. Two patients reported mild persistent perineal discomfort and 1 had a recurrent contracture after stent placement, which was successfully managed with placement of a second overlapping stent. Overall, 89% of the patients were satisfied with the results. CONCLUSIONS: UroLume stent placement followed by artificial urinary sphincter can be a successful method for treating recurrent severe bladder neck contracture and incontinence. There is minimal morbidity with the procedures, and the combination offers a much more attractive treatment alternative compared to urinary diversion or chronic catheter drainage.

Aged↗
PubMed2000

Recent advances in the management of the neurogenic bladder.

Proper evaluation of the neurogenic bladder remains the cornerstone for accurate management of the neurologically impaired patient. Due to the inherent progressive nature of many neurologic disorders causing bladder dysfunction and lack of targeted medical therapy, much work has been done and needs to be done to advance the management of this often-difficult patient population. This article reviews the latest advances in managing the neurogenic bladder. For ease of review, the neurogenic bladder can be divided into 2 basic categories: first, bladders that fail to empty successfully and, second, those that fail to store urine adequately. Therapy should be based on these categories because poor therapeutic results are seen when a standard treatment is prescribed for the wrong bladder condition. Given the success of other specialties (physical medicine and rehabilitation, orthopedics, and neurology) at improving and prolonging the lives of the neurologically impaired patient, the urologist has an increasing responsibility to evaluate and treat the neurogenic bladder effectively over a life span that is approaching that of the normal population.

Anastomosis, Surgical↗
PubMed2000

Is fascia lata allograft material trustworthy for pubovaginal sling repair?

OBJECTIVES: In a recent publication, cadaveric fascia lata used for pubovaginal sling procedures was reported as having an early, rapid, and high failure rate. Recurrent incontinence was reported to occur from 1 week to 5 months after surgery. The study concluded that cadaveric tissue should not be used for urogynecologic procedures. Their results, however, were significantly different from what we found in clinical practice. We reviewed our series of cadaveric pubovaginal slings to determine the occurrence of rapid breakdown of cadaveric sling tissue leading to recurrent stress urinary incontinence. METHODS: At our institution, since June 1998, pubovaginal slings have been performed using only cadaveric fascia lata. Because all of the failures in the aforementioned study occurred within 5 months (mean 11 weeks) of surgery, we included in our series only patients with a minimum of 12 months of follow-up to ensure a long enough follow-up period for failure of the donor tissue to occur. Duration of follow-up and current continence status was documented. RESULTS: Twenty-six patients, with a mean follow-up of 15 months (range 12 to 20), were evaluated. Twenty-four of 26 (92%) patients used one or fewer pads per day: 20 of 26 (77%) were completely dry and 4 of 26 (15.4%) used only one pad per day. Two of 26 (7.7%) required two pads per day. Twenty-five of 26 (96%) reported being "significantly improved" and were "very pleased and satisfied" with the results of surgery. CONCLUSIONS: We found no evidence of rapid degradation of solvent-dehydrated cadaveric tissue resulting in early recurrent incontinence. We think these data support the continued use of cadaveric allograft material, especially given its intraoperative and postoperative advantages. Clearly, long-term evaluation of the durability of the cadaveric slings in comparison with autologous fascia is warranted.

Adult↗
PubMed2000

Removal of UroLume endoprosthesis: experience of the North American Study Group for detrusor-sphincter dyssynergia application.

PURPOSE: We present the experience of the North American UroLume Multicenter Study Group with removal of the UroLume endoprosthesis. MATERIALS AND METHODS: A total of 160 neurologically impaired patients were enrolled in the North American UroLume Multicenter Study Group for detrusor external sphincter dyssynergia application. Analysis was performed in 2 groups of patients in which the device was removed during insertion and after implantation, respectively. RESULTS: Device retrieval was required during insertion in 21 patients (13%) mainly due to misplacement or migration in 17. Extraction was done with minimal complications and in all but 2 cases subsequent UroLume implantation was successful. Of 158 men with the device in place 31 (19.6%) required removal. In 34 procedures 44 devices were removed, mainly due to migration. Time from implantation to removal ranged from 4 days to 66 months (mean 22 months). The UroLume was removed en bloc in 20 cases and in parts or wire by wire in 19. The majority of patients had no or minimal complications after extraction. Only 2 patients had serious temporary complications, including bleeding and urethral injury, with no lasting consequences. No malignancy developed as a result of UroLume insertion. CONCLUSIONS: While there is a potential for urethral injury and bleeding, UroLume endoprosthesis removal is largely a simple procedure with minimal complications and consequences.

Humans↗
PubMed2000

Ball urethroplasty combined with Marshall-Marchetti-Krantz urethropexy versus suburethral sling in patients with intrinsic sphincter deficiency and urethral hypermobility.

OBJECTIVE: It was our goal to compare the efficacy of a suburethral fascial sling with that of a combination of Marshall-Marchetti-Krantz urethropexy and Ball urethroplasty in patients with intrinsic sphincter deficiency and urethral hypermobility. STUDY DESIGN: This study consisted of a retrospective observational evaluation of patients from 2 separate practice sites. Preoperative and postoperative data were collected from patients' medical records. The long-term results were based on a mailed questionnaire addressing bladder symptoms and quality-of-life issues. RESULTS: Among a total of 48 patients, 37 (77. 1%) responded in the group undergoing Marshall-Marchetti-Krantz urethropexy combined with Ball urethroplasty, and 30 out of 35 (85.7%) patients replied in the suburethral fascial sling group. The mean length of follow-up was 2. 7 years (range, 1-5 years). The patients were similar in age, hormonal status, parity, and previous bladder neck surgery. Similar cure and improvement were demonstrated in both groups (86.6% in the suburethral fascia group and 89.2% in the group with the Marshall-Marchetti-Krantz procedure combined with Ball urethroplasty). No significant differences were found in urinary incontinence types, irritable bladder symptoms, voiding difficulties, or quality-of-life measures. CONCLUSIONS: The suburethral fascial sling and a procedure consisting of Marshall-Marchetti-Krantz urethropexy combined with Ball urethroplasty have similar results in patients with intrinsic sphincter and urethral hypermobility.

Adult↗
PubMed2000

Urethral devices for managing stress urinary incontinence.

Although surgery remains the gold standard for managing the majority of patients with stress urinary incontinence or retention, not all patients are suitable candidates or desire surgery. For these patients, several urethral caps and inserts are available, which are described. In approximately 50% of patients, satisfactory control is achieved. Further investigation undoubtedly will yield better devices to serve the large number of patients with urinary control problems.

Equipment Design↗
PubMed2000

Video urodynamic findings in men with the central cord syndrome.

PURPOSE: The central cord syndrome reportedly has a favorable prognosis and rehabilitation outcome. However, to our knowledge the status of the lower urinary tract in patients with the central cord syndrome is unclear. We report on 22 men with the central cord syndrome who were evaluated by video urodynamics. MATERIALS AND METHODS: From 1986 to the present we identified 22 men with a mean age of 51 years who had the central cord syndrome and were included in the Houston Veterans Affairs spinal cord registry. All patients underwent video urodynamic evaluation a mean of 34.5 months after injury. RESULTS: Video urodynamic testing for vesicourethral dysfunction was normal in 3 patients, while it showed bladder outlet obstruction secondary to benign prostatic hyperplasia in 2, detrusor areflexia in 4, external detrusor-sphincter dyssynergia in 11, detrusor hyperreflexia with a synergistic external urethral sphincter in 1 and detrusor hypocontractility in 1. Urinary tract infection recurred in 3 patients with external detrusor-sphincter dyssynergia and urolithiasis developed in 2. CONCLUSIONS: Urodynamic testing revealed a high incidence of external detrusor-sphincter dyssynergia in men with the central cord syndrome. Due to the potential for upper tract deterioration all patients with the central cord syndrome should undergo baseline urodynamic studies. Those at high risk for upper tract deterioration with external detrusor-sphincter dyssynergia or a loss of compliance should be treated more aggressively with clean intermittent catheterization and anticholinergic medication when possible.

Adult↗
PubMed1999

Efficacy of antimicrobial-impregnated bladder catheters in reducing catheter-associated bacteriuria: a prospective, randomized, multicenter clinical trial.

OBJECTIVES: To examine the efficacy of bladder catheters impregnated with minocycline and rifampin in reducing catheter-associated bacteriuria. METHODS: A prospective, randomized clinical trial was conducted at five academic medical centers. Patients undergoing radical prostatectomy were randomized to receive intraoperatively either regular silicone bladder catheters (control catheters) or silicone bladder catheters impregnated with minocycline and rifampin (antimicrobial-impregnated catheters). Catheters remained in place for a mean of 2 weeks. Urine cultures were obtained at about 3, 7, and 14 days after catheter insertion. Bacteriuria was defined as the growth of organism(s) in urine at a concentration of 10(4) colony-forming units per milliliter or greater. RESULTS: Kaplan-Meier analysis demonstrated that it took significantly longer for patients (n = 56) who received the antimicrobial-impregnated catheters to develop bacteriuria than those (n = 68) who received the control catheters (P = 0.006 by the log-rank test). Patients who received the antimicrobial-impregnated catheters had significantly lower rates of bacteriuria than those in the control group both at day 7 (15.2% versus 39.7%) and at day 14 (58.5% versus 83.5%) after catheter insertion. Patients who received the antimicrobial-impregnated catheters had significantly lower rates of gram-positive bacteriuria than the control group (7.1% versus 38.2%; P <0.001) but similar rates of gram-negative bacteriuria (46.4% versus 47.1%) and candiduria (3.6% versus 2.9%). The antimicrobial-impregnated catheters provided zones of inhibition against Enterococcus faecalis and Escherichia coli, both at baseline and on removal. CONCLUSIONS: Bladder catheters impregnated with minocycline and rifampin significantly reduced the rate of gram-positive catheter-associated bacteriuria up to 2 weeks after catheter insertion.

Anti-Bacterial Agents↗
PubMed1999

Long-term followup of the North American multicenter UroLume trial for the treatment of external detrusor-sphincter dyssynergia.

PURPOSE: We determine the long-term efficacy and safety of the UroLume stent as minimally invasive treatment for external detrusor-sphincter dyssynergia in spinal cord injured men. MATERIALS AND METHODS: A total of 160 spinal cord injured men with a mean age plus or minus standard deviation of 36.3 +/- 12.1 years (range 16 to 74) were prospectively treated with an endoprosthesis at 15 centers as part of the North American UroLume trial for external detrusor-sphincter dyssynergia. Urodynamic parameters, including voiding pressure, residual urine volume and bladder capacity, were compared before treatment and at 1, 2, 3, 4 and 5 years after treatment. RESULTS: Mean voiding pressure was 75.1 +/- 28.2 cm. water before treatment in the 160 patients, and 37.4 +/- 23.9 at year 1 in 97, 39.5 +/- 22.2 at year 2 in 84, 42.6 +/- 27.3 at year 3 in 61, 46.3 +/- 33.2 at year 4 in 57 and 44.2 +/- 28.9 cm. at year 5 in 41 after stent insertion (p <0.001). Residual urine volume decreased after stent placement and was maintained throughout the 5-year followup (p <0.001). Mean cystometric capacity remained constant from 269 +/- 155 before insertion to 337 +/- 182 ml. 5 years later (p = 0.17). Hydronephrosis and autonomic dysreflexia improved or stabilized in most patients with functioning stents. Stent explant was necessary in 24 patients (15%), of whom 4 (16.7%) had another stent implanted. CONCLUSIONS: The UroLume stent demonstrates long-term safety and efficacy for the treatment of external detrusor-sphincter dyssynergia. The outcome was similar in men with and without previous sphincterotomy.

Adolescent↗
PubMed1999

Collagen polyp of the urinary tract: a report of two cases.

Injection of collagen into the urethral or bladder wall has gained popularity as an effective way to control urinary stress incontinence. The same technique has recently been used to improve function of urinary pouches surgically created from intestinal segments. We report the first two cases of a polypoid lesion in these structures, both of which were composed of injected collagen. The first lesion occurred in the ileal urinary pouch of a 41-year-old paraplegic man who had cystoprostatectomy for severe spasm and repeated infection of the bladder. The pouch, removed for repeated infection, showed a 2.5-cm submucosal polyp. The second lesion was in the urethra of a 71-year-old man who underwent radical retropubic prostatectomy for prostatic carcinoma, followed by artificial urethral sphincter placement. Follow-up cystoscopy revealed a proximal urethral polyp that was biopsied. In both cases, collagen was injected into these structures for controlling urinary incontinence. Histologically, the polyps were caused by submucosal accumulation of injected collagen with pathognomonic features (i.e., eosinophilic, homogeneous, and poorly cellular material that was faintly positive by the periodic acid-Schiff and strongly positive by the trichome stain). These two cases expand the list of differential diagnoses for a polypoid lesion in the intestinal and urinary tracts and illustrate the morphology of injected collagen. A familiarity with these changes is diagnostically helpful because an increasing number of specimens removed for therapeutic failure of injected collagen are expected.

Adult↗
PubMed1998

Bladder leak point pressure: the measure for sphincterotomy success in spinal cord injured patients with external detrusor-sphincter dyssynergia.

PURPOSE: Transurethral resection of the external sphincter in patients with spinal cord injury and detrusor-external sphincter dyssynergia has high failure and reoperation rates. Retrospectively we examined elevated bladder leak point pressure after transurethral resection of the external sphincter as an indicator of failure. MATERIALS AND METHODS: A total of 55 spinal cord injury patients (mean age 50 years) underwent 1 or more sphincter resections, most recently a mean of 11 years ago. We reviewed the most recent urodynamic studies for bladder leak point pressure, bladder compliance and persisting external detrusor-sphincter dyssynergia. Each patient was assessed for the presence of an indwelling catheter, upper tract damage, stones, bacteriuria, autonomic dysreflexia and vesicoureteral reflux. The incidence of each of these urodynamic and clinical parameters among patients with bladder leak point pressure less than 40 cm. water was compared to the incidence among those with bladder leak point pressure greater than 40 cm. water. RESULTS: Patients with bladder leak point pressure greater than 40 cm. water had a significantly higher incidence of upper tract damage (p = 0.021) and persisting external detrusor-sphincter dyssynergia (p = 0.00008). The incidence of an indwelling catheter was no different between patients with bladder leak point pressure less than and greater than 40 cm. water. CONCLUSIONS: Bladder leak point pressure greater than 40 cm. water is a valid indicator of failure of transurethral resection of the external sphincter since there is a significantly higher incidence of upper tract damage and persisting external detrusor-sphincter dyssynergia in these patients. Patients with favorable urodynamic parameters after transurethral resection of the external sphincter but with indwelling catheters were poorly selected for this procedure. Furthermore, those without an indwelling catheter after transurethral resection of the external sphincter may still have adverse urodynamic parameters and are at significant risk for upper tract damage.

Adult↗
PubMed1998

Continent ileocecal augmentation cystoplasty.

OBJECTIVES: To evaluate the use of the ileocecal bowel segment for bladder augmentation in a select group of patients who need a low pressure, high capacity urinary storage mechanism and a continent, catheterisable, cutaneous stoma that, because of their physical limitations, is easier to catheterize than their native urethra. METHODS: We reviewed records of 23 continent ileocecal augmentation cystoplasties performed over the last 5 1/2 years. The goals of the operation, patient selection criteria, pre-operative evaluation, operative technique, and post-operative evaluation with results were studied. RESULTS: Twenty-three patients underwent the procedure with the average follow-up being 26.9 months (range 3-67 months). Bladder capacity was increased by an average of 276.8 milliliters (ml). No metabolic problems have been detected, and 95% (22/23 patients) are continent via their urethra and stoma. CONCLUSIONS: This unique modification of the Indiana continent urinary reservoir is not technically difficult to create and is relatively free of complications. The bladder capacity is greatly increased and post-operative continence rates are excellent. Finally, the quality of life for these patients has been significantly improved by their ability to access the augmented bladder independently via an abdominal stoma.

Adult↗
PubMed1998

Management of impending penile prosthesis erosion with a polytetrafluoroethylene distal wind sock graft.

PURPOSE: Erosion of penile prostheses can be calamitous, often leaving patients unable to accommodate further implants. There is a paucity of literature describing impending erosion of penile prosthesis. We report on 5 patients with impending erosion of a penile prosthesis who underwent polytetrafluoroethylene distal wind sock graft placement. MATERIALS AND METHODS: From 1993 to 1997, 5 patients with a mean age of 49 years and impending penile prosthesis erosion underwent 6 revisions using a polytetrafluoroethylene distal wind sock graft. Two patients underwent simultaneous bilateral grafts while 1 patient underwent separate right and left grafts 3 years apart. Indications for reconstruction included distal migration of the prosthetic cylinders into the glans in 4 patients and impingement of the distal urethra in 2. Of the patients 3 were spinal cord injured, 1 had lumbar radiculopathy and 1 had a history of pelvic irradiation. Inflatable prostheses were implanted in 4 patients, while 1 received a malleable prosthesis. RESULTS: Patients underwent a mean of 1.5 penile prosthetic revisions (0 to 4) before diagnosis of impending erosion. An interval of 8 to 144 months (mean 66) elapsed from the most recent penile prosthesis insertion until distal wind sock graft placement. Mean operative time was 1 hour 51 minutes (1.3 to 2.5 hours). Mean hospital stay was 6.3 days (3 to 12). At a mean followup of 32 months (0.7 to 5.2 years) all patients had satisfactory and functional erections with no pain or evidence of impending erosion or penile prosthesis infection. CONCLUSIONS: Erosion of a penile prosthesis can have disastrous consequences. We describe a safe and effective technique for managing impending penile prosthesis erosion using a polytetrafluoroethylene distal wind sock graft.

Humans↗
PubMed1998

The correlation of urodynamic findings with cranial magnetic resonance imaging findings in multiple sclerosis.

PURPOSE: To our knowledge there are no studies of the correlation between urinary complaints or urodynamic findings in multiple sclerosis and magnetic resonance imaging (MRI) findings. We investigated the correlation of urodynamic results in multiple sclerosis patients with voiding complaints to the cranial MRI findings. We also sought to correlate urodynamic results in these patients with International Prostate Symptom Scores (IPSS). MATERIALS AND METHODS: We retrospectively reviewed urodynamic results and cranial MRI findings in 90 multiple sclerosis patients (64 women, 26 men, mean age 44.5 years) with voiding complaints. The most recent urodynamic study and cranial MRI for each patient were reviewed. The interval between the 2 studies and MRI was no more than 6 months. Detrusor contractions were categorized as areflexic, hyporeflexic, hyperreflexic or hyperreflexic with impaired contractility. The presence of impaired compliance or detrusor-external sphincter dyssynergia was recorded. The cranial MRI findings were categorized on the basis of the presence of atrophy or enhancing lesions, total number of lesions and size of largest lesion. The urodynamic and MRI findings were correlated. Of the patients 40 who had urodynamic studies done within the last 6 months completed the IPSS, and severity of cranial MRI findings in these patients was correlated with the IPSS results. In addition, the presence of irritative findings of detrusor hyperreflexia or detrusor hyperreflexia with impaired contractility was correlated with the irritative score (sum of questions 1, 2, 4, 7), and the presence of detrusor-external sphincter dyssynergia was correlated with the obstructive score (sum of questions 3, 5, 6). RESULTS: There was no correlation between urodynamic category, presence of impaired compliance or presence of detrusor-external sphincter dyssynergia and any of the MRI findings of atrophy or enhancing lesions, total number of lesions or size of the largest lesions. In the patients who completed the IPSS there was no correlation between total number of lesions and IPSS score. There was no correlation between the presence of detrusor-external sphincter dyssynergia and obstructive score on the IPSS or between the presence of detrusor hyperreflexia and irritative score. CONCLUSIONS: Although patients with multiple sclerosis often are followed closely with urodynamic studies and cranial MRI, there appears to be no correlation between these 2 studies. Symptom scores also do not appear to correlate with urodynamic findings. Therefore, urodynamic studies appear to be warranted and irreplaceable in the evaluation of voiding dysfunction in multiple sclerosis patients.

Adolescent↗