Holly A Roy1, Jeremy Nettleton2, Camilla Blain3, Catherine Dalton3, Bilal Farhan4, Ailton Fernandes5, Petros Georgopoulos6, Sabine Klepsch7, John Lavelle8, Evangelista Martinelli9, Jalesh N Panicker10, Ivan Radoja11, Christina-Anastasia Rapidi12, Ricardo Pereira E Silva13, Katarina Tudor14, Adrian S Wagg15, Marcus J Drake16. 1. Neurosurgery Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK. 2. Department of Urology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK. 3. Atkinson Morley Regional Neurosciences Centre, St George's University Hospitals NHS Foundation Trust, London, UK. 4. UTMB Health Division of Urology, Galveston, Texas. 5. Department of Urology, State University of Rio de Janeiro, Rio de Janeiro, Brazil. 6. Department of Urology and Pelvic Floor Unit, Aarhus University Hospital, Aarhus, Denmark. 7. Neurology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK. 8. Veteran Affairs Palo Alto Health Care System, Palo Alto, California. 9. Department of Urology, "SS. Annunziata" Hospital, Taranto, Italy. 10. Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK. 11. Department of Urology, University Hospital Centre Osijek, Faculty of Medicine, The J. J. Strossmayer University of Osijek, Osijek, Croatia. 12. PRM Department, General Hospital "G. Gennimatas", Athens, Greece. 13. Department of Urology, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal. 14. Department of Neurology, Unit for Headaches, Neurogenic Pain and Spinal Disorders, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia. 15. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 16. Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol Urological Institute, Bristol, UK.
Abstract
AIM: Lower urinary tract symptoms (LUTS) are a common urological referral, which sometimes can have a neurological basis in a patient with no formally diagnosed neurological disease ("occult neurology"). Early identification and specialist input is needed to avoid bad LUTS outcomes, and to initiate suitable neurological management. METHODS: The International Continence Society established a neurological working group to consider: Which neurological conditions may include LUTS as an early feature? What diagnostic evaluations should be undertaken in the LUTS clinic? A shortlist of conditions was drawn up by expert consensus and discussed at the annual congress of the International Neurourology Society. A multidisciplinary working group then generated recommendations for identifying clinical features and management. RESULTS: The relevant conditions are multiple sclerosis, multiple system atrophy, normal pressure hydrocephalus, early dementia, Parkinsonian syndromes (including early Parkinson's Disease and Multiple System Atrophy) and spinal cord disorders (including spina bifida occulta with tethered cord, and spinal stenosis). In LUTS clinics, the need is to identify additional atypical features; new onset severe LUTS (excluding infection), unusual aspects (eg, enuresis without chronic retention) or "suspicious" symptoms (eg, numbness, weakness, speech disturbance, gait disturbance, memory loss/cognitive impairment, and autonomic symptoms). Where occult neurology is suspected, healthcare professionals need to undertake early appropriate referral; central nervous system imaging booked from LUTS clinic is not recommended. CONCLUSIONS: Occult neurology is an uncommon underlying cause of LUTS, but it is essential to intervene promptly if suspected, and to establish suitable management pathways.
AIM: Lower urinary tract symptoms (LUTS) are a common urological referral, which sometimes can have a neurological basis in a patient with no formally diagnosed neurological disease ("occult neurology"). Early identification and specialist input is needed to avoid bad LUTS outcomes, and to initiate suitable neurological management. METHODS: The International Continence Society established a neurological working group to consider: Which neurological conditions may include LUTS as an early feature? What diagnostic evaluations should be undertaken in the LUTS clinic? A shortlist of conditions was drawn up by expert consensus and discussed at the annual congress of the International Neurourology Society. A multidisciplinary working group then generated recommendations for identifying clinical features and management. RESULTS: The relevant conditions are multiple sclerosis, multiple system atrophy, normal pressure hydrocephalus, early dementia, Parkinsonian syndromes (including early Parkinson's Disease and Multiple System Atrophy) and spinal cord disorders (including spina bifida occulta with tethered cord, and spinal stenosis). In LUTS clinics, the need is to identify additional atypical features; new onset severe LUTS (excluding infection), unusual aspects (eg, enuresis without chronic retention) or "suspicious" symptoms (eg, numbness, weakness, speech disturbance, gait disturbance, memory loss/cognitive impairment, and autonomic symptoms). Where occult neurology is suspected, healthcare professionals need to undertake early appropriate referral; central nervous system imaging booked from LUTS clinic is not recommended. CONCLUSIONS: Occult neurology is an uncommon underlying cause of LUTS, but it is essential to intervene promptly if suspected, and to establish suitable management pathways.