Neurological Causes of Genitourinary Dysfunction
Primary Neurological Conditions Causing Genitourinary Issues
- Diabetic autonomic neuropathy causes sexual dysfunction, including erectile dysfunction and retrograde ejaculation in men, and decreased sexual desire, increased pain during intercourse, decreased arousal, and inadequate lubrication in women, according to the American Diabetes Association 1, 2, 3
- Diabetic autonomic neuropathy leads to neurogenic bladder with symptoms including urinary incontinence, nocturia, frequent urination, urgency, and weak urinary stream, as reported by the American Diabetes Association 2, 3
- Evaluation of bladder function should be performed for patients with recurrent urinary tract infections, pyelonephritis, incontinence, or palpable bladder, as recommended by the American Diabetes Association 3
- Cauda equina syndrome causes bilateral radiculopathy with progressive neurological deficits in the legs, leading to urinary retention or incontinence and fecal incontinence, according to the British Society of Neurosurgeons 4
- Spinal cord injury results in neurogenic lower urinary tract dysfunction (NLUTD) with symptoms varying based on the level and completeness of injury, as reported by the American Urological Association 5, 6
Pathophysiological Mechanisms
- Autonomic dysreflexia can occur in patients with spinal cord injuries above T6, causing dangerous blood pressure elevations in response to bladder distension, according to the American Urological Association 5, 7
- Detrusor-sphincter dyssynergia is characterized by uncoordinated contraction of the bladder and urethral sphincter, leading to functional obstruction, as reported by the American Urological Association 5, 6
Evaluation and Management
- Patients with NLUTD should be categorized as low-risk, moderate-risk, high-risk, or unknown risk based on potential for upper urinary tract damage, as recommended by the American Urological Association 5, 6
- Initial evaluation should include detailed history, physical examination, urinalysis, and post-void residual measurement in patients who void spontaneously, according to the American Urological Association 5
- Antimuscarinics (e.g., oxybutynin) or beta-3 adrenergic receptor agonists can be used for detrusor overactivity, with awareness of side effects including dry mouth, constipation, and cognitive effects, as reported by the American Urological Association 6
- Intermittent catheterization is preferred over indwelling catheters due to lower rates of UTI and urethral trauma, according to the American Urological Association 6, 8
- Suprapubic catheters may be associated with higher rates of bladder stones than clean intermittent catheterization, as reported by the American Urological Association 8