Lower Urinary Tract Symptoms as an Indicator of Occult Neurologic Disease: A System-first Framework for Urologic Practice.

Abstract

Purpose of review: Lower urinary tract symptoms (LUTS) may precede or accompany the other symptoms of neurologic disease and may be the presenting clinical manifestations of central, peripheral, or autonomic nervous system dysfunction. In clinical practice, urologists are often the first specialists to evaluate these patients, potentially before underlying neurologic disease has been identified. Early recognition of neurologic contributors to LUTS may help prevent diagnostic delay. This review aims to provide a symptom-based framework that highlights common urologic presentations associated with underlying neurologic disease, along with urodynamic findings of concern, to support earlier recognition of neurological disease in patients presenting with LUTS.

Recent findings: Recent work has characterized neurologic diseases associated with LUT dysfunction using disease-based frameworks. Despite this, gaps persist in routine urologic evaluation, including inconsistent screening for neurological symptoms and limited incorporation of focused neurologic history and examination. Certain urodynamic patterns are increasingly recognized as suggestive of neurological pathology but are not consistently interpreted within this context. Barriers to timely neurologic evaluation, including limited specialist availability and prolonged wait times, further contribute to diagnostic delay. As a result, there is growing recognition of the need for urologists to identify clinical features within LUTS presentation that should prompt consideration of neurologic disease, though practical strategies for integrating these insights into routine care remain limited. A symptom-based framework for evaluating LUTS can enhance early detection of neurologic disease in urologic practice. Urologists and pelvic health specialists should have a broad understanding of what clinical characteristics associated with LUTS should trigger concern for underlying neurological disease and should always consider neurological disease in the differential diagnosis. This review provides a practical, clinically oriented overview of neurologic disease in LUTS assessment, including guidance on screening questions, initial testing considerations, urodynamic interpretation, and referral, particularly in the settings with limited neurology access. Algorithms are provided to facilitate early recognition of occult neurological disease within routine urologic practice.