ABSTRACT
Autonomic pathways are important in the regulation of both lower urinary tract and
sexual function, and their interruption in neurological pathologies predictably results
in variable urogenital dysfunction, depending mainly on the level of the lesion. A
normal neurological examination of a patient with urogenital complaints should exclude
an underlying neurological pathology, and the neurologist should become involved in
the management of symptoms. Electromyography can be of value in the diagnosis and
management of cauda equina lesions and multiple system atrophy, but neurophysiological
investigations are of no importance in the diagnosis of neurogenic sexual dysfunction.
Urodynamic studies have proven helpful in determining the type and management of lower
urinary tract dysfunction. Oral anticholinergics usually combined with clean intermittent
catheterizations are the first-line treatment options for neurogenic lower urinary
tract dysfunction, with intravesical treatments emerging as the main alternative in
intractable incontinence. The availability of effective oral phosphodiesterase inhibitors
has revolutionized the management of erectile dysfunction, but treatment of ejaculatory
and orgasmic disorders as well as of female sexual dysfunction still remains problematic.
KEYWORDS
Urinary tract - neural control - autonomic neuropathies - overactive bladder - detrusor
hyperreflexia - urodynamic - sexual/erectile dysfunction - treatment - sildenafil
