TY - JOUR
T1 - 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)
AU - Panicker, Jalesh N
AU - Fanciulli, Alessandra
AU - Skoric, Magdalena Krbot
AU - Kaplan, Tamara
AU - Aleksovska, Katina
AU - Adamec, Ivan
AU - Averbeck, Marcio Augusto
AU - Campese, Nicole
AU - Guaraldi, Pietro
AU - Leys, Fabian
AU - Moreno-Palacios, Jorge
AU - Simeoni, Sara
AU - Stankovic, Iva
AU - Wright, Sarah
AU - Batla, Amit
AU - Blok, Bertil
AU - Hentzen, Claire
AU - Hilz, Max Josef
AU - Kessler, Thomas M
AU - Madersbacher, Helmut
AU - Nair, Kannan Rajasekharan
AU - Nair, Krishnan Padmakumari Sivaraman
AU - Pakzad, Mahreen
AU - Traon, Anne Pavy-Le
AU - Peryer, Guy
AU - Przydacz, Mikolaj
AU - Sakakibara, Ryuji
AU - Saraf, Udit
AU - Smith, Matthew
AU - Struhal, Walter
AU - Thijs, Roland D
AU - Tudor, Katarina Ivana
AU - Tutaj, Marcin
AU - Vodušek, David B
AU - Wenning, Gregor
AU - Habek, Mario
N1 - © 2025 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
PY - 2025/4
Y1 - 2025/4
N2 - 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.
AB - 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.
KW - Humans
KW - Sexual Dysfunction, Physiological/therapy
KW - Neurology/standards
KW - Neurologists/standards
KW - Societies, Medical/standards
KW - Nervous System Diseases/complications
KW - Urinary Bladder, Neurogenic/therapy
KW - Urology/standards
KW - Europe
KW - Evidence-Based Medicine
U2 - 10.1111/ene.70119
DO - 10.1111/ene.70119
M3 - Journal article
C2 - 40208234
SN - 1351-5101
VL - 32
SP - e70119
JO - European Journal of Neurology
JF - European Journal of Neurology
IS - 4
ER -