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Urogenital Symptoms in Neurologic Patients

Panicker, Jalesh N. MD, DM, FRCP

doi: 10.1212/CON.0000000000000448
Review Articles

ABSTRACT Purpose of Review: Lower urinary tract and sexual dysfunction are commonly reported sequelae of neurologic disease and have a significant impact on quality of life. This article presents an up-to-date summary of the clinical presentation, investigations, and treatment options for urogenital dysfunction in patients with neurologic disease.

Recent Findings: The pattern of lower urinary tract dysfunction is influenced by the site of the neurologic lesion. The risk for developing upper urinary tract damage is considerably less in patients with slowly progressive nontraumatic neurologic disorders, as compared to those with spinal cord injury or spina bifida. Investigations such as urinalysis, ultrasonography, and urodynamics provide further information about the cause and nature of lower urinary tract dysfunction. Antimuscarinic agents are the first-line management of urinary incontinence; however, side effect profile and anticholinergic burden should be considered when prescribing medications. β3-Adrenergic receptor agonists are a promising alternative oral medication. Tibial and sacral neuromodulation have been shown to be effective for managing incontinence, as well as urinary retention due to Fowler syndrome. Intradetrusor injections of onabotulinumtoxinA have revolutionized the management of neurogenic detrusor overactivity.

Summary: Neurologic patients reporting urogenital symptoms require a comprehensive evaluation for planning a patient-tailored approach to management. Neurologists are increasingly inquiring about lower urinary tract and sexual functions and becoming involved in the management of these disorders.

Address correspondence to Dr Jalesh N. Panicker, Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N3BG, UK,

Relationship Disclosure: Dr Panicker has received personal compensation for serving as a speaker for Astellas Pharma and for serving as an advisor for Wellspect Healthcare. Dr Panicker has received research/grant support as an investigator for Firstkind Limited, Multiple Sclerosis Society of the UK, and Parkinson’s UK, and has received publishing royalties from Cambridge University Press.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Panicker reports no disclosure.

© 2017 American Academy of Neurology
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