European Academy of Neurology (EAN)/European Federation of Autonomic Societies (EFAS)/International Neuro-Urology Society (INUS) Guidelines for Practising Neurologists on the Assessment and Treatment of Neurogenic Urinary and Sexual Symptoms (NEUROGED Guidelines)

Panicker JN, Fanciulli A, Skoric MK, Kaplan T, Aleksovska K, Adamec I, Averbeck MA, Campese N, Guaraldi P, Leys F, Moreno-Palacios J, Simeoni S, Stankovic I, Wright S, Batla A, Blok B, Hentzen C, Hilz MJ, Kessler TM, Madersbacher H, Nair KR, Nair KPS, Pakzad M, Traon APL, Peryer G, Przydacz M, Sakakibara R, Saraf U, Smith M, Struhal W, Thijs RD, Tudor KI, Tutaj M, Vodušek DB, Wenning G, Habek M (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 32

Article Number: e70119

Journal Issue: 4

DOI: 10.1111/ene.70119

Abstract

Background: Urinary and sexual symptoms are common following neurological disease, and we aimed to develop multidisciplinary inter-society evidence-based management guidelines. Methods: The ADAPTE framework was used, and a systematic search of guidelines published in different languages was performed. Guidelines, consensus statements, and systematic reviews were included, and guideline quality was appraised using AGREE II. Patient representatives reviewed the relevance and suitability of recommendations. A modified Delphi process integrating the Evidence to Decision framework adapted from GRADE and the Oxford Centre for Evidence Based Medicine system was used to reach consensus on recommendation wording and strength. Results: Recommendations were drafted, using guidelines/consensus statements (59 urinary, 50 sexual), systematic reviews (8 urinary, 2 sexual) and others (7 urinary,13 sexual), and wordings/strengths achieved at least 80% consensus through 2 Delphi rounds. Eleven evidence-based recommendations, 19 good practice statements, and 8 consensus-based recommendations were made. Individuals with neurological diseases should be asked about urogenital symptoms and undergo targeted physical examination when appropriate. Urinary symptom assessments include urinalysis, bladder diary completion, and post-void residual volume measurement. Treatments include fluid intake optimization, pelvic physiotherapy, tibial nerve stimulation, and oral medications. Urinary retention is managed by intermittent catheterization. Antibiotics should not be recommended to treat asymptomatic bacteriuria. Suprapubic catheterization is preferred for long-term catheterization. A comprehensive sexual history should be taken, focusing on multidimensional factors affecting sexual health. Treatments include lubricants, vibrators, and phosphodiesterase-5 inhibitors. Red flag symptoms warrant a shared-care approach with specialist colleagues. Conclusions: The 38 NEUROGED recommendations will guide neurologists to comprehensively manage urogenital symptoms reported by individuals with neurological diseases.

Authors with CRIS profile

Involved external institutions

University College Hospital United Kingdom (GB) Centre Hospitalier Universitaire (CHU) de Toulouse France (FR) University of East Anglia United Kingdom (GB) Jagiellonian University Medical College Poland (PL) Chiba Hospital Japan (JP) Amrita University / Amrita Vishwa Vidyapeetham India (IN) University of Bristol United Kingdom (GB) Karl Landsteiner Privatuniversität für Gesundheitswissenschaften GmbH Austria (AT) Leiden University Medical Center Netherlands (NL) Zagreb University Hospital Centre / Klinički bolnički centar Zagreb (KBC) Croatia (HR) Medizinische Universität Innsbruck Austria (AT) Ljubljana University Medical Centre (Ljubljana UMC) / Univerzitetni klinični center Ljubljana Slovenia (SI) National Hospital For Neurology and Neurosurgery United Kingdom (GB) Brigham and Women's Hospital (BWH) United States (USA) (US) European Academy of Neurology (EAN) Austria (AT) Hospital Moinhos de Vento Brazil (BR) IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB) Italy (IT) Centro Medico Nacional Siglo XXI Mexico (MX) Clinical Center of Serbia Serbia (RS) University College London (UCL) United Kingdom (GB) Erasmus University Medical Center (MC) Netherlands (NL) Hôpital Tenon France (FR) Universitätsklinik Balgrist Switzerland (CH) University of Sheffield United Kingdom (GB)

How to cite

APA:

Panicker, J.N., Fanciulli, A., Skoric, M.K., Kaplan, T., Aleksovska, K., Adamec, I.,... Habek, M. (2025). European Academy of Neurology (EAN)/European Federation of Autonomic Societies (EFAS)/International Neuro-Urology Society (INUS) Guidelines for Practising Neurologists on the Assessment and Treatment of Neurogenic Urinary and Sexual Symptoms (NEUROGED Guidelines). European Journal of Neurology, 32(4). https://doi.org/10.1111/ene.70119

MLA:

Panicker, Jalesh N., et al. "European Academy of Neurology (EAN)/European Federation of Autonomic Societies (EFAS)/International Neuro-Urology Society (INUS) Guidelines for Practising Neurologists on the Assessment and Treatment of Neurogenic Urinary and Sexual Symptoms (NEUROGED Guidelines)." European Journal of Neurology 32.4 (2025).

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