Results of the present study are interpreted to suggest that tadalafil may ameliorate MS-associated bladder overactivity by restoring insulin-activated detrusor relaxation through molecular mechanisms that are associated with preservation of the bladder mucosal IR/IRS/PI3K/AKT/eNOS pathway and detrusor cGMP production (Fig. 4). This evidence concerns the gene AKT1 and myeloid sarcoma.