Marcus J Drake, Salvador Arlandis, Marcio A Averbeck, Enrico Finazzi Agrò, Claire Hentzen, Giovanni Mosiello, Jalesh Panicker, Matthew Smith, Katie Webb
{"title":"我们能否改进常规泌尿科评估以排除下尿路功能障碍的神经源性原因？ICI-RS 2024。","authors":"Marcus J Drake, Salvador Arlandis, Marcio A Averbeck, Enrico Finazzi Agrò, Claire Hentzen, Giovanni Mosiello, Jalesh Panicker, Matthew Smith, Katie Webb","doi":"10.1002/nau.70028","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>After presentation with urinary symptoms, an underlying neurological mechanism sometimes emerges subsequently. Increased awareness may bring earlier diagnosis, improving prognosis and outcomes.</p><p><strong>Methods: </strong>A 2024 International Consultation on Incontinence Research Society think-tank considered the clinical pathway for identification of an undiagnosed neurological or autonomic contribution precipitating urinary symptoms, and the implications for prognosis.</p><p><strong>Results: </strong>Alongside adult-onset neurogenic conditions, potential for missed diagnosis includes congenital and pediatric-acquired neurogenic conditions, which may become symptomatic during a growth spurt due to spinal cord tethering. Detailed assessment is needed, also considering bowel and sexual dysfunction, with timely referral to neurology to reduce preventable progression of disease. In neurological assessment, control of micturition is often poorly characterized compared with other aspects of spinal cord function and the cranial nerves. Screening tools may be used to identify people who have increased likelihood of particular conditions, but currently available tools are either single-system or population specific. In addition to the general pelvic examination, the assessment of sacral reflexes and pelvic sensations can suggest a neurological mechanism, though the sensitivity and specificity of the neuro-urological examination is unknown. Including the results of the neuro-perineal examination in the urodynamic report may improve the interpretation of the results and potentially support a neurological aetiology.</p><p><strong>Conclusion: </strong>Future research should consider the value of neuro-urological examination in diagnosis of occult neurological disease, the development of an occult neurology screening tool/risk scoring based on pelvic organ symptoms, and appropriateness of non-neurologist practitioners requesting neurological investigations such as MRI scanning.</p><p><strong>Clinical trial registration: </strong>Does not apply.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"609-615"},"PeriodicalIF":1.8000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920931/pdf/","citationCount":"0","resultStr":"{\"title\":\"Can We Improve Our Routine Urological Assessment to Exclude Neurogenic Causes for Lower Urinary Tract Dysfunction? ICI-RS 2024.\",\"authors\":\"Marcus J Drake, Salvador Arlandis, Marcio A Averbeck, Enrico Finazzi Agrò, Claire Hentzen, Giovanni Mosiello, Jalesh Panicker, Matthew Smith, Katie Webb\",\"doi\":\"10.1002/nau.70028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>After presentation with urinary symptoms, an underlying neurological mechanism sometimes emerges subsequently. Increased awareness may bring earlier diagnosis, improving prognosis and outcomes.</p><p><strong>Methods: </strong>A 2024 International Consultation on Incontinence Research Society think-tank considered the clinical pathway for identification of an undiagnosed neurological or autonomic contribution precipitating urinary symptoms, and the implications for prognosis.</p><p><strong>Results: </strong>Alongside adult-onset neurogenic conditions, potential for missed diagnosis includes congenital and pediatric-acquired neurogenic conditions, which may become symptomatic during a growth spurt due to spinal cord tethering. Detailed assessment is needed, also considering bowel and sexual dysfunction, with timely referral to neurology to reduce preventable progression of disease. In neurological assessment, control of micturition is often poorly characterized compared with other aspects of spinal cord function and the cranial nerves. Screening tools may be used to identify people who have increased likelihood of particular conditions, but currently available tools are either single-system or population specific. In addition to the general pelvic examination, the assessment of sacral reflexes and pelvic sensations can suggest a neurological mechanism, though the sensitivity and specificity of the neuro-urological examination is unknown. Including the results of the neuro-perineal examination in the urodynamic report may improve the interpretation of the results and potentially support a neurological aetiology.</p><p><strong>Conclusion: </strong>Future research should consider the value of neuro-urological examination in diagnosis of occult neurological disease, the development of an occult neurology screening tool/risk scoring based on pelvic organ symptoms, and appropriateness of non-neurologist practitioners requesting neurological investigations such as MRI scanning.</p><p><strong>Clinical trial registration: </strong>Does not apply.</p>\",\"PeriodicalId\":19200,\"journal\":{\"name\":\"Neurourology and Urodynamics\",\"volume\":\" \",\"pages\":\"609-615\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920931/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurourology and Urodynamics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/nau.70028\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/10 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurourology and Urodynamics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/nau.70028","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/10 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Can We Improve Our Routine Urological Assessment to Exclude Neurogenic Causes for Lower Urinary Tract Dysfunction? ICI-RS 2024.
Aims: After presentation with urinary symptoms, an underlying neurological mechanism sometimes emerges subsequently. Increased awareness may bring earlier diagnosis, improving prognosis and outcomes.
Methods: A 2024 International Consultation on Incontinence Research Society think-tank considered the clinical pathway for identification of an undiagnosed neurological or autonomic contribution precipitating urinary symptoms, and the implications for prognosis.
Results: Alongside adult-onset neurogenic conditions, potential for missed diagnosis includes congenital and pediatric-acquired neurogenic conditions, which may become symptomatic during a growth spurt due to spinal cord tethering. Detailed assessment is needed, also considering bowel and sexual dysfunction, with timely referral to neurology to reduce preventable progression of disease. In neurological assessment, control of micturition is often poorly characterized compared with other aspects of spinal cord function and the cranial nerves. Screening tools may be used to identify people who have increased likelihood of particular conditions, but currently available tools are either single-system or population specific. In addition to the general pelvic examination, the assessment of sacral reflexes and pelvic sensations can suggest a neurological mechanism, though the sensitivity and specificity of the neuro-urological examination is unknown. Including the results of the neuro-perineal examination in the urodynamic report may improve the interpretation of the results and potentially support a neurological aetiology.
Conclusion: Future research should consider the value of neuro-urological examination in diagnosis of occult neurological disease, the development of an occult neurology screening tool/risk scoring based on pelvic organ symptoms, and appropriateness of non-neurologist practitioners requesting neurological investigations such as MRI scanning.
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Neurourology and Urodynamics welcomes original scientific contributions from all parts of the world on topics related to urinary tract function, urinary and fecal continence and pelvic floor function.
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