Guidelines

Neuro-urology

1. INTRODUCTION

1.1. Aim and objectives

The European Association of Urology (EAU) Neuro-Urology Guidelines aim to provide information for clinical practitioners on the incidence, definitions, diagnosis, therapy, and follow-up of neuro-urological disorders. These Guidelines reflect the current opinion of experts in this specific pathology and represent a state-of-the-art reference for all clinicians, as of the publication date.

The terminology used and the diagnostic procedures advised throughout these Guidelines follow the recommendations for investigations of the lower urinary tract (LUT) as published by the International Continence Society (ICS) [1-3]. Readers are advised to consult other EAU Guidelines that may address different aspects of the topics discussed in this document.

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2. Panel composition

The EAU Neuro-Urology Guidelines Panel consists of an international multidisciplinary group of neuro-urological experts. All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU website: https://uroweb.org/guidelines/neuro-urology.

1.3. Available publications

A quick reference document, the Pocket Guidelines, is available in print and as an app for iOS and Android devices. These are abridged versions which may require consultation with the full text version. A guideline summary has also been published in European Urology [4]. All are available through the EAU website: https://uroweb.org/guidelines/neuro-urology.

1.4. Publication history and summary of changes

1.4.1. Publication history

The EAU Guidelines on Neuro-Urology were first published in 2003. Standard procedure for EAU Guidelines includes an annual assessment of newly published literature in the field to guide future updates. This 2024 Neuro-Urology Guidelines present an update of the 2022 publication.

1.4.2. Summary of changes

All chapters of the 2024 Neuro-Urology Guidelines have been updated, based on the 2023 version of the Guidelines. References have been added throughout the document resulting in various text updates and changes in evidence summaries and recommendations including but not limited to:

  • Updates throughout Table 1 and the inclusion of data for Myasthenia gravis.
  • A new recommendation for blood pressure and heartrate monitoring in section 3.3.7.4
  • A new paragraph on other drugs used as medical therapy for neuro-urological symptoms in section 3.4.2.3 as well as a new summary of evidence (SOE) and recommendation for mirabegron in section 3.4.2.4
  • Multiple text updates in section 3.4.3. on the various surgical intervention options for SUI in neuro-urological patients.
  • A new SOE and recommendation for sacral neuromodulation in section 3.4.3.6
  • A new recommendation against the use of dipstick urine analysis to screen for UTI in neuro-urological patients in section 3.5.4.

1.5. Background

The function of the LUT is mainly storage and voiding of urine, which is regulated by the nervous system that co-ordinates the activity of the urinary bladder and bladder outlet. The part of the nervous system that regulates LUT function is disseminated from the peripheral nerves in the pelvis to highly specialised cortical areas. Any disturbance of the nervous system involved, can result in neuro-urological symptoms. The extent and location of the disturbance will determine the type of LUT dysfunction, which can be symptomatic or asymptomatic. Neuro-urological symptoms can cause a variety of long-term complications; the most significant being deterioration of renal function. Since symptoms and long-term complications do not correlate [5], it is important to identify patients with neuro-urological symptoms, and establish if they have a low or high risk of subsequent complications. The risk of developing upper urinary tract (UUT) damage and renal failure is much lower in patients with slowly progressive non-traumatic neurological disorders than in those with spinal cord injury or spina bifida [6]. In summary, treatment and intensity of follow-up examinations are based on the type of neuro-urological disorder and the underlying cause.