Sacral neuromodulation success in a long-term multiple sclerosis patient with neurogenic bladder disorder and detrusor underactivity: a case report

Multiple sclerosis (MS) is a leading cause of non-traumatic disability in young adults and is frequently associated with lower urinary tract symptoms (LUTS). Sacral neuromodulation (SNM) has recently emerged as a promising treatment for neurogenic urinary and bowel disorders; however, its application in patients with MS remains underexplored.

We report the case of a 46-year-old male with primary progressive MS who presented with severe LUTS, including urgency, urgency urinary incontinence, hesitancy, and urinary retention. These symptoms were attributed to neurogenic lower urinary tract dysfunction with detrusor underactivity during the voiding phase and low-pressure detrusor overactivity during the filling phase. After conventional treatments proved insufficient, the patient underwent a two-stage implantation of an InterStim II SNM device. Although initial complications occurred, including device erosion, subsequent reimplantation with an InterStim X device resulted in substantial symptom improvement, safe removal of the suprapubic catheter, and restoration of spontaneous voiding.

This case highlights the potential role of SNM in alleviating LUTS associated with detrusor underactivity in patients with MS. The findings underscore the importance of careful patient selection, multidisciplinary management, and further research into long-term outcomes and strategies for mitigating complications. These observations add to the growing body of evidence suggesting that SNM may represent a therapeutic option for selected patients with neurogenic lower urinary tract dysfunction due to MS when conventional therapies fail.