What neurologists should know about bladder and sexual problems

Evidence-based guidelines are in preparation regarding the management of neurogenic urinary and sexual dysfunction, intended for the practising neurologist. Prof. Jalesh Panicker (University College London, UK) explained what and why general neurologists need to know about bladder and sexual issues and what are the indications for a referral to urology.

Bladder and sexual problems are common following neurological disease and have a considerable impact on the quality-of-life. However, only a small proportion of neurology patients with significant bladder problems receive specific treatment. There is a lack of awareness amongst practising neurologists, argued Prof. Panicker, and limited to no involvement. Therefore, in a joint effort, the EAN –together with the European Federation of Autonomic Societies (EFAS) and the International Neuro-Urology Society (INUS)– is developing guidelines for the practising neurologist on neurogenic urogenital dysfunction management (NEUROGED).

The task force consists of 37 members from 17 countries on 4 continents. Prof. Panicker added that evidence for managing neurogenic bladder and sexual dysfunction is low, but that several high-quality guidelines on the subject already exist. The guidelines committee identified 38 questions; they formulated evidence-based recommendations on 11, consensus-based recommendations on 8, and good practice statements on 19 of these questions [1].

These are some of the good practice statements on the assessment of bladder symptoms:

• Neurologists should actively ask about bladder symptoms, as well as about sexual problems
• Neurologists should perform a targeted physical examination
• Urinalysis (dipstick testing) should be performed at the initial evaluation of bladder symptoms and when clinically indicated at follow-up visits

Prof. Panicker stressed that urologists must not be “flooded” with patients referred to them by the neurologist. These red flags justify referral to a urologist:

• Risk of developing upper urinary tract damage
• Suspicion of concomitant primary urological pathology
• Poor response or significant side effects to first-line treatments for bladder symptoms

Treatments of bladder symptoms mentioned include bladder retraining, pelvic floor exercises, tibial nerve stimulation, intermittent catheterisation, and agents such as antibiotics, antimuscarinic drugs, and beta-3 receptor agonists. Possible treatments for sexual problems included are education, lubricants, vacuum devices, and prostaglandins.

The NEUROGED guidelines will be published in late 2023 or 2024. Prof. Panicker hopes that they will serve as a benchmark for neurologists across the world in the assessment and management of urogenital symptoms reported by their patients. Neurologists may have doubts about their role here, as expressed after the presentation by a member of the audience, who stated: “Of the proposed recommendations, 75% are way beyond what I need to know.” Thus, there is work ahead for Prof. Panicker and his colleagues beyond making this guideline, which may otherwise be ignored.

1. Panicker J, et al. Management of neurogenic lower urinary tract and sexual dysfunction for the practising neurologist. EAN 2023 Annual Meeting, 1–4 July, Budapest, Hungary.

Copyright ©2023 Medicom Medical Publishers



Posted on 7 September 20237 September 2023