{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:01:46Z","timestamp":1792789306749,"version":"4.5.0"},"reference-count":42,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T00:00:00Z","timestamp":1715817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Multiple sclerosis (MS) is increasing in the pediatric population and, as in adults, symptoms vary among patients. In children the first manifestations can sometimes overlap with acute neurological symptoms. Urological symptoms have not been much studied in childhood. We shared our experience with MS urological manifestation in children. Methods: This article is a retrospective evaluation of all children with MS, according to the Krupp criteria, who also present with urological symptoms. We collected demographic and clinical history, the MR localization of demyelinating lesions, urological symptoms, and exams. Results: We report on six MS pediatric cases with urological manifestation. Urinary symptoms, characterized by urinary incontinence in five patients and urinary retention in one patient, appeared in a different time frame from MS diagnosis. Urodynamic exams showed both overactive and underactive bladder patterns. Treatment was defined according to lower urinary tract dysfunction, using clean intermittent catheterization, oxybutynin, and intradetrusor Onabotulinum Toxin-A injection. A low acceptance rate of invasive evaluation and urological management was observed. Conclusions: The MS diagnosis was traumatic for all our patients. We believe it is important to address urological care in young people from the time of diagnosis for prompt management; it could be useful to include a pediatric urologist in multidisciplinary teams.<\/jats:p>","DOI":"10.3390\/children11050601","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T09:30:03Z","timestamp":1715851803000},"page":"601","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Lower Urinary Tract Dysfunction in Pediatric Patients with Multiple Sclerosis: Diagnostic and Management Concerns"],"prefix":"10.3390","volume":"11","author":[{"given":"Maria Laura","family":"Sollini","sequence":"first","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"},{"name":"Clinical Science and Translational Medicine, Tissue Engineering and Remodeling Biotechnologies for Body Function PhD School, University of Rome Tor Vergata, Via Cracovia 50, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9813-6288","authenticated-orcid":false,"given":"Chiara","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Barone","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"},{"name":"Pediatric Surgery, University of Genoa, DINOGMI, Largo Paolo Daneo 3, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"Capitanucci","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Maria","family":"Zaccara","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Crescentini","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1685-8936","authenticated-orcid":false,"given":"Enrico","family":"Castelli","sequence":"additional","affiliation":[{"name":"Neurorehabilitation Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gessica","family":"Della Bella","sequence":"additional","affiliation":[{"name":"Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Scorletti","sequence":"additional","affiliation":[{"name":"Neonatal Surgery Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3336-9205","authenticated-orcid":false,"given":"Laura","family":"Papetti","sequence":"additional","affiliation":[{"name":"Developmental Neurology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Monte","sequence":"additional","affiliation":[{"name":"Developmental Neurology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela Ada Noris","family":"Ferilli","sequence":"additional","affiliation":[{"name":"Developmental Neurology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6602-103X","authenticated-orcid":false,"given":"Massimiliano","family":"Valeriani","sequence":"additional","affiliation":[{"name":"Developmental Neurology Unit, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9626-9519","authenticated-orcid":false,"given":"Giovanni","family":"Mosiello","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1007\/s10072-016-2801-9","article-title":"Estimated prevalence of multiple sclerosis in Italy in 2015","volume":"38","author":"Battaglia","year":"2017","journal-title":"Neurol. Sci."},{"key":"ref_2","unstructured":"MS International Federation (2024, January 15). Atlas of MS 2020\u2014Epidemiology Report. Available online: https:\/\/www.msif.org\/resource\/atlas-of-ms-2020\/."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"RAlroughani, R., and Boyko, A. (2018). Pediatric multiple sclerosis: A review. BMC Neurol., 18.","DOI":"10.1186\/s12883-018-1026-3"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"508","DOI":"10.5603\/PJNNS.a2020.0069","article-title":"Pediatric multiple sclerosis\u2014Current status of epidemiology, diagnosis and treatment","volume":"54","author":"Brola","year":"2020","journal-title":"Neurol. Neurochir. Polska"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.1212\/01.wnl.0000259447.77476.a9","article-title":"Clinical features of children and adolescents with multiple sclerosis","volume":"68","author":"Ness","year":"2007","journal-title":"Neurology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S74","DOI":"10.1212\/WNL.0000000000003028","article-title":"Pediatric multiple sclerosis: Clinical features and outcome","volume":"87","author":"Waldman","year":"2016","journal-title":"Neurology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/S0387-7604(03)00035-4","article-title":"Multiple sclerosis in children","volume":"25","author":"Gadoth","year":"2003","journal-title":"Brain Dev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101054","DOI":"10.1016\/j.spen.2023.101054","article-title":"Pediatric Multiple Sclerosis","volume":"46","author":"Kornbluh","year":"2023","journal-title":"Semin. Pediatr. Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S2352-4642(18)30026-9","article-title":"MRI and laboratory features and the performance of international criteria in the diagnosis of multiple sclerosis in children and adolescents: A prospective cohort study","volume":"2","author":"Fadda","year":"2018","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1177\/1352458515618541","article-title":"Neurogenic lower urinary tract dysfunction in the early disease phase of paediatric multiple sclerosis","volume":"22","author":"Scheepe","year":"2015","journal-title":"Mult. Scler. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/S0003-9993(99)90282-4","article-title":"Lower urinary tract dysfunction and disability status in patients with multiple sclerosis","volume":"80","author":"Giannantoni","year":"1999","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1177\/1352458513484547","article-title":"International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: Revisions to the 2007 definitions","volume":"19","author":"Krupp","year":"2013","journal-title":"Mult. Scler. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1002\/ana.22366","article-title":"Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria","volume":"69","author":"Polman","year":"2011","journal-title":"Ann. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s11910-018-0886-7","article-title":"Pediatric Multiple Sclerosis: An Update","volume":"18","author":"Otallah","year":"2018","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1111\/dmcn.14212","article-title":"Paediatric multiple sclerosis: A new era in diagnosis and treatment","volume":"61","author":"Duignan","year":"2019","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1212\/01.wnl.0000259422.44235.a8","article-title":"Consensus definitions proposed for pediatric multiple sclerosis and related disorders","volume":"68","author":"Krupp","year":"2007","journal-title":"Neurology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1212\/01.wnl.0000338630.20412.45","article-title":"Role of MRI in the differentiation of ADEM from MS in children","volume":"72","author":"Callen","year":"2009","journal-title":"Neurology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"13","DOI":"10.15844\/pedneurbriefs-29-2-4","article-title":"MRI to Discriminate Pediatric MS from ADEM","volume":"29","author":"Rubin","year":"2015","journal-title":"Pediatr. Neurol. Briefs"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1212\/WNL.0b013e3181f4d821","article-title":"Cognitive and psychosocial features in childhood and juvenile MS: Two-year follow-up","volume":"75","author":"Amato","year":"2010","journal-title":"Neurology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1177\/1352458506075651","article-title":"The neurogenic bladder in multiple sclerosis: Review of the literature and proposal of management guidelines","volume":"13","author":"Ruffion","year":"2007","journal-title":"Mult. Scler. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"91","DOI":"10.7224\/1537-2073.2019-030","article-title":"Prevalence of Lower Urinary Tract Symptoms in People with Multiple Sclerosis: A Systematic Review and Meta-analysis","volume":"22","author":"Coote","year":"2020","journal-title":"Int. J. MS Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1179\/2045772315Y.0000000021","article-title":"Overactive bladder symptoms in patients with multiple sclerosis: Frequency, severity, diagnosis and treatment","volume":"39","author":"Bilen","year":"2016","journal-title":"J. Spinal Cord Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.eururo.2007.08.039","article-title":"Botulinum Toxin A Detrusor Injections in Patients with Neurogenic Detrusor Overactivity Significantly Decrease the Incidence of Symptomatic Urinary Tract Infections","volume":"53","author":"Bentaleb","year":"2008","journal-title":"Eur. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.jpurol.2020.11.006","article-title":"Definitions, indications and practice of urotherapy in children and adolescents: A standardization document of the International Children\u2019s Continence Society (ICCS)","volume":"17","author":"Hussong","year":"2021","journal-title":"J. Pediatr. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s11934-016-0582-6","article-title":"Underactive Bladder","volume":"17","author":"Aggarwal","year":"2016","journal-title":"Curr. Urol. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.juro.2018.07.066","article-title":"Higher Neural Correlates in Patients with Multiple Sclerosis and Neurogenic Overactive Bladder Following Treatment with Intradetrusor Injection of OnabotulinumtoxinA","volume":"201","author":"Khavari","year":"2019","journal-title":"J. Urol."},{"key":"ref_27","unstructured":"Sakakibara, R. (2023). Handbook of Neurourology, Springer."},{"key":"ref_28","first-page":"e47086","article-title":"Pelvic Floor Muscle Training and Its Benefits for Multiple Sclerosis Patients Suffering From Urinary Incontinence and Sexual Dysfunction","volume":"15","author":"Sapouna","year":"2023","journal-title":"Cureus"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/j.urology.2006.05.038","article-title":"Comparison of electric stimulation and oxybutynin chloride in management of overactive bladder with special reference to urinary urgency: A randomized placebo-controlled trial","volume":"68","author":"Wang","year":"2006","journal-title":"Urology"},{"key":"ref_30","unstructured":"B\u00f8, K., Berghmans, B., M\u00f8rkved, S., and Van Kampen, M. (2014). Evidence-Based Physical Therapy for the Pelvic Floor: Bridging Science and Clinical Practice, Elsevier Inc.. [2nd ed.]."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"377","DOI":"10.4111\/icu.2016.57.6.377","article-title":"Secondary and tertiary treatments for multiple sclerosis patients with urinary symptoms","volume":"57","author":"Tracey","year":"2016","journal-title":"Investig. Clin. Urol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/S0302-2838(03)00010-1","article-title":"Urodynamic Results of Sacral Neuromodulation Correlate with Subjective Improvement in Patients with an Overactive Bladder","volume":"43","author":"Scheepens","year":"2003","journal-title":"Eur. Urol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Sparaco, M., and Bonavita, S. (2022). Pelvic Floor Dysfunctions and Their Rehabilitation in Multiple Sclerosis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11071941"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"100","DOI":"10.5152\/tud.2023.22241","article-title":"Efficacy of Tibial Nerve Stimulation in Neurogenic Lower Urinary Tract Dysfunction Among Patients with Multiple Sclerosis: A Systematic Review and Meta-analysis","volume":"49","author":"Tahmasbi","year":"2023","journal-title":"Urol. Res. Pract."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"17562872231177779","DOI":"10.1177\/17562872231177779","article-title":"Percutaneous tibial nerve stimulation in the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: A historically controlled study","volume":"15","author":"Carilli","year":"2023","journal-title":"Ther. Adv. Urol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1097\/01.ju.0000119961.58222.86","article-title":"Percutaneous Tibial Nerve Neuromodulation is Well Tolerated in Children and Effective for Treating Refractory Vesical Dysfunction","volume":"171","author":"Capitanucci","year":"2004","journal-title":"J. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1016\/S0022-5347(01)63185-9","article-title":"Bladder cancer in patients with multiple sclerosis treated with cyclophosphamide","volume":"159","author":"Demonty","year":"1998","journal-title":"J. Urol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1038\/nrurol.2016.53","article-title":"Management of neurogenic bladder in patients with multiple sclerosis","volume":"13","author":"Panicker","year":"2016","journal-title":"Nat. Rev. Urol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1080\/00365590600679137","article-title":"Reliability of bladder volume measurement with BladderScan\u00ae in paediatric patients","volume":"40","author":"Capitanucci","year":"2006","journal-title":"Scand. J. Urol. Nephrol."},{"key":"ref_40","first-page":"S8","article-title":"Are psychological comorbidities important in the aetiology of lower urinary tract dysfunction-ICI-RS 2018?","volume":"38","author":"Vrijens","year":"2019","journal-title":"Neurourol. Urodyn."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1007\/s10072-023-07281-y","article-title":"Neuropsychological performances, quality of life, and psychological issues in pediatric onset multiple sclerosis: A narrative review","volume":"45","author":"Tarantino","year":"2023","journal-title":"Neurol. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1007\/s004150050508","article-title":"Urinary, faecal and sexual dysfunction in patients with multiple sclerosis","volume":"246","author":"Hennessey","year":"1999","journal-title":"J. Neurol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/5\/601\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:43:31Z","timestamp":1760107411000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/5\/601"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,16]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["children11050601"],"URL":"https:\/\/doi.org\/10.3390\/children11050601","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,16]]}}}