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MS – Bladder Dysfunction Management — SCE Neurology MCQ

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EasyMultiple Sclerosis & CNS InflammationMS – Bladder Dysfunction ManagementSCE Neurology

A 55-year-old man with MS has a 3-year history of lower urinary tract symptoms including urgency, frequency, and urge incontinence. Urodynamic studies confirm detrusor overactivity. He has already tried oral oxybutynin with intolerable dry mouth. What is the next appropriate management step per NICE NG100?

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Correct answer: A — Mirabegron or an alternative antimuscarinic

For detrusor overactivity in MS, NICE NG100 recommends antimuscarinics as first-line. If oxybutynin is not tolerated, alternative antimuscarinics (solifenacin, tolterodine) or mirabegron (a beta-3 agonist with fewer anticholinergic side effects) should be tried. Botulinum toxin injection into the detrusor is reserved for cases refractory to oral therapy. A: ISC is for incomplete bladder emptying, not overactivity. C: Desmopressin may help nocturia but does not treat detrusor overactivity. D: Botulinum toxin is next-line if oral therapy fails. E: Suprapubic catheter is a last resort.

Reference: NICE NG100 MS (2022); NICE NG123 Urinary Incontinence (2019)