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Semin Neurol 2003; 23(4): 443-452
DOI: 10.1055/s-2004-817728
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Evaluation and Treatment of Autonomic Disorders of the Urogenital System

Apostolos N. Apostolidis, Claire J. Fowler
  • Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Publication History

Publication Date:
15 April 2004 (online)

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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

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