Urogenital symptoms impact the quality of life of neurological patients considerably and neurologists have been showing a greater interest in recent years towards assessing and treating these symptoms. For the first time, management guidelines have been developed specifically for neurologists through a collaboration between the EAN and partnering societies, the International Neuro-Urology Society (INUS) and the European Federation of Autonomic Societies (EFAS).
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A unique method of guideline development was followed that involved adapting or adopting recommendations from existing guidelines and preparing recommendations de novo through a consensus if not available in the included guidelines. The evidence base for several of the assessments and treatments was low, and but for 11 evidence-based recommendations, the remaining were either good practice statements or consensus-based recommendations.
In total, 38 recommendations were developed that have been grouped under the assessment and treatment of urinary and sexual symptoms. These recommendations address the bedside assessment of patients, including history taking and targeted physical examination. Investigations that can be carried out in a neurology service such as testing for urinary tract infections, completing a bladder diary, measuring the postvoid residual volume and performing blood tests measuring renal functions are addressed. The guidelines give a good practice statement on the issue of asymptomatic bacteriuria, stating that antibiotics should not be routinely recommended to treat asymptomatic bacteriuria except when occurring in the context of pregnancy, planned urological procedures or immunomodulatory treatments. Recommendations have been made on treatments such as providing advice on optimising fluid intake and bladder retraining, and specific treatments such as antimuscarinic agents and tibial nerve stimulation. Another issue addressed by the paper is the multidimensional nature of sexual dysfunction following neurological disease. Recommendations address treatments such as phosphodiesterase 5 inhibitors and prostaglandin injections in men, and the use of vibratory devices and lubricants. Good practice statements have been developed that recommend when care should be shared with other specialists.
The paper includes a checklist of urinary and sexual symptoms that can be followed in clinic, and two algorithms illustrate the care that neurological patients should be receiving when they report urinary and sexual symptoms to their neurologists.
For the patient and caregiver
Troublesome urinary and sexual symptoms commonly occur following neurological disease and the NEUROGED guidelines consists of recommendations that have been developed between urologists and neurologist addressing how to assess and treat these symptoms. Individuals should undergo an assessment that includes enquiring about symptoms and undergoing tests such as testing the urine for infection and measuring the volume of urine remaining in the bladder after passing urine (known as the postvoid residual volume). Recommendations on fluid intake and pelvic floor muscle exercises have been included, as well as on medications and nerve stimulation. Treatments for managing difficulties with sexual performance are addressed in these guidelines. Illustrations that depict the assessment of urinary and sexual symptoms have been developed.
Read the full guideline paper, published in the European Journal of Neurology, here (Open Access).
