Dr Lysanne Campeau (McGill University, Canada) held a state-of-the-art lecture on the basic neurological workup any urologist seeing a male LUTS patient should consider [1]. Key urological symptoms underlying neurological disease may be storage and voiding symptoms, erectile dysfunction, retrograde ejaculation, enuresis, loss of filling sensation, or unexplained stress urinary incontinence.
Common neurological aetiologies for male LUTS can be Parkinson’s disease (PD), multiple system atrophy (MSA), or normal pressure hydrocephalus characterised by dementia, abnormal gait, and urinary incontinence. Concomitant LUTS can also be a sign of multiple sclerosis (MS), several different spinal cord conditions, or cerebral white matter disease.
Dr Campeau obtains relevant history to help make a differential diagnosis, asking the patient and/or partner about memory issues, visual disturbances (MS), anosmia (PD), and speech changes (MSA). The urologist should note if there is a resting tremor indicative of PD, back pain (cauda equina syndrome), saddle anaesthesia, bowel dysfunction and incontinence, weakness or numbness in lower limbs (MS), or gait or balance problems.
The focused physical exam, to determine whether a referral to the neurologist is necessary, uses a top-to-bottom approach. Dr Campeau pointed out that many of these can be observed in the normal course of entry (e.g. gait) and discussion:
- mental status (attention, language, memory);
- speech (croaky) and masked facies;
- blood pressure (orthostatic);
- motor system (speed of movement, Cogwheel rigidity, tremor);
- coordination (ataxia [finger-nose-finger], repetitive finger tapping);
- bulbocavernosus reflex (Dr Campeau rarely performs this in practice);
- sensory system (perineal); and
- gait assessment (shuffling, wide stance, arm swing).
She recommended that a urinalysis with renal function should be undertaken, and where appropriate, a voiding diary and an ultrasound of the bladder and/or kidney may be indicated. Urodynamic studies can be particularly informative. She cautioned that it is essential to consult with a neurologist prior to any surgery or other irreversible intervention.
- Campeau L, et al. EAU20 Virtual Congress, 17-26 July 2020, State-of-the-art-lecture.
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Table of Contents: EAU 2020
Featured articles
Surgical Techniques and Safety
The new adjustable artificial sphincter victo: Surgical technique and results after a follow-up of more than one year
New urosepsis data from the SERPENS study
Stones
Intra-operative cone-beam computed tomography for detecting residual stones in percutaneous nephrolithotomy
Pressure and temperature: do high-power lasers pose a threat?
Radiation stewardship for patient and endourologist
New lithotripter data: improved stone clearance
Renal Cancer
Beyond the limits of ultrasound: Three dimensional augmented reality robot assisted partial nephrectomy (3D AR-RAPN) for complex renal masses
Imaging guided surgery with augmented reality for robotic partial nephrectomy
KEYNOTE-426: no QoL differences pembrolizumab + axitinib versus sunitinib
Debate: upfront cytoreductive nephrectomy or not?
Robotic-assisted partial nephrectomy: lower morbidity
Bladder Cancer
Reduced BCG frequency, faster NMIBC recurrence
Nadofaragene firadenovec effective in BCG-unresponsive papillary NMIBC
Understanding MIBC biology for novel treatment options
Prostate Cancer & Imaging
Transperineal laser ablation of prostate
Prostatectomy: R-LRPE better than LRPE for continence
PSMA PET-CT staging is 27% more accurate
Docetaxel + hormonal therapy: improved prostate cancer PFS
ARAMIS subgroup analysis: darolutamide benefits across PSADT groups
Large patient-driven survey reveals QoL issues after prostate cancer treatment
Targeting steroid sulphatase in resistant prostate cancer cells
Good tolerance of post-RP radiotherapy ± short-term ADT
BPH & LUTS
Minimizing post-operative stress urinary incontinence after HoLEP: Our preliminary experience and short-term results of ‘’En Bloc’’ technique with early apical release
LUTS 2-year outcomes: aquablation versus TURP
HoLEP versus PVP in prospective randomised trial
Testis Cancer & Andrology
Peyronie’s disease: surgical options
Infertility and testis cancer risk: causal or association?
32% more men complain of reduced sex drive in 2019 versus 2009
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