Assessing lower urinary tract symptoms in the neuro-urologic patient

The neurological history from male LUTS patients or their partners is essential. Urologists should perform a careful physical exam and perhaps a referral to neurologists prior to any invasive or irreversible treatment.

A focused physical exam can determine whether a referral to the neurologist is necessary

It is essential to elicit the neurological history from male lower urinary tract symptoms (LUTS) patients or their partners. Urologists should perform a careful physical exam. Prior to any invasive or irreversible treatment, the patient should be referred to a neurologist.

Dr. Lysanne Campeau (McGill University, Canada) held a state-of-the-art lecture on the basic neurological workup any urologist seeing a male LUTS patient should consider1. Key urological symptoms underlying neurological disease may include storage, voiding symptoms, erectile dysfunction, retrograde ejaculation, enuresis, loss of filling sensation, or unexplained stress urinary incontinence.

Common neuronal etiologies for male LUTS can be Parkinson’s disease (PD), multiple system atrophy (MSA), or normal pressure hydrocephalus characterized by dementia, abnormal gait, and urinary incontinence. Concomitant LUTS can also be a sign of multiple sclerosis (MS), several different spinal cord conditions, or cerebral white matter disease.

Dr. Campeau obtains relevant history to help make a differential diagnosis, asking the patient and/or partner about memory issues, visual disturbances (MS), anosmia (PD), and speech changes (MSA). The urologist should note if there is a resting tremor indicative of PD, back pain (cauda equina syndrome), saddle anaesthesia, bowel dysfunction and incontinence, weakness, or numbness in lower limbs (MS), or gait or balance problems.

The focused physical exam, to determine whether a referral to the neurologist is necessary, uses a top-to-bottom approach. Dr. Campeau pointed out that many of these can be observed in the normal course of entry (e.g. gait) and patient consultation:

She recommended that a urinalysis with renal function should be undertaken, and where appropriate, voiding diary and an ultrasound of the bladder and/or kidney may be indicated. Urodynamic studies can be particularly informative. She cautioned that it is essential to consult with a neurologist prior to any surgery or other irreversible intervention.

Reference:
1. Campeau L, et al. Basic neurological workup in a male LUTS patient: Keypoints for daily clinical practice. EAU20 Virtual Congress, 17-26 July 2020, State-of-the-art-lecture.

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