Lower Urinary Tract and Sexual Dysfunction in Neurological Patients

Background: Lower urinary tract dysfunction (LUTD) and sexual dysfunction (SD) are common in neurological patients due to a combination of lesions affecting relevant neural control, constraints imposed by sensorimotor and cognitive deficits and – particularly for SD – psychosocial consequences of chronic neurological disease. Summary: This review summarizes the etiology, diagnosis and treatment of LUTD and SD in neurological patients. Key Messages: LUTD may lead to serious health problems; both LUTD and SD significantly affect quality of life. Management of patients with spinal cord injury and dysraphism is undertaken in specialized centers according to established guidelines. Treatment of neurological patients with noncomplicated neurogenic LUTD or SD should preferentially be guided by a neurologist. Clinical Impact: For rational treatment of urinary symptoms, an accurate assessment is mandatory; the bladder and the sphincter need to be defined as normal, overor underactive. Urodynamic testing is the gold standard for functional diagnosis; assessment of residual urine and uroflow are the minimal requirements before considering management. Dysfunction of desire, arousal and orgasm (ejaculation) may Received: August 8, 2013 Accepted: February 9, 2014 Published online: July 2, 2014 David B. Vodušek Division of Neurology University Medical Centre and Medical Faculty, University of Ljubljana SI– 1525 Ljubljana (Slovenia) E-Mail david.vodusek @ kclj.si © 2014 S. Karger AG, Basel 0014–3022/14/0722–0109$39.50/0