EAN 2023 | EAN-EFAS-INUS: management of neurogenic lower urinary tract and sexual dysfunction for neurologists

This is a three-year collaborative project between the EAN, the International Neuro-Urology Society, and the European Federation of Autonomic Societies, and the actual rationale for this is that the guidelines just don’t exist for neurologists. So, we have several robustly made guidelines for neurogenic bladder and sexual management, which is available essentially for the urologists or for management, but when it comes to a neurologist, in practice many of the recommendations aren’t that applicable and relevant. And so, this is something that is made in collaboration between urologists and neurologists and is essentially designed for the practicing neurologist, be it a general neurologist or a specialist, like in multiple sclerosis or Parkinson’s, to actually assess and treat bladder and sexual dysfunction.

Number one is that as a neurologist, one should ask about bladder and sexual dysfunction, I think that’s itself an achievement if that is something that we can convey. Also, it is knowing which are the baseline assessments, such as a patient with bladder problems, they’re measuring their post-void residual volume, if it’s about sexual dysfunction, a targeted physical examination. And then also understanding the first line treatments that as a neurologist, one would be able to initiate, providing awareness about the different sort of therapeutic approaches and about side effects. One key bit is when to refer, so red flags on when a neurologist should involve their specialist urologists or urogynecologist, and that’s been included in both the section on bladder dysfunction and on sexual dysfunction.

We start out by taking a good history, we provide some guidance on what a good history on bladder dysfunction is like. Moving on to a targeted physical examination. Investigations such as bloods, measuring the post-void residual, and there are recommendations on recommending first line assessments like looking at fluids, about pelvic floor muscle training, and specific treatments, like antimuscarinic agents, beta-3 receptor agonists, alpha blockers. When it comes to sexual dysfunction, quite similar approaches in terms of assessment, examination, and treatments for male sexual dysfunction, such as the phosphodiesterase-5 inhibitors. Moving on to second line treatments such as a vacuum device and specific red flags on when to refer. For example, if it’s a patient with sexual dysfunction who has also blood in their sperm, or pain during intercourse, it needs to be looked into. For bladder dysfunction if they have blood in their urine or if they have a high post-void residue of urine, or if they’re deemed to have a high risk of developing upper tract damage as per their neurology or their findings in their baseline investigations then they need to be referred on.