Vodušek David B
Division of Neurology, University Medical Centre and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
Eur Neurol. 2014;72(1-2):109-15. doi: 10.1159/000360529. Epub 2014 Jul 2.
Lower urinary tract dysfunction (LUTD) and sexual dysfunction (SD) are common in neurological patients due to a combination of lesions affecting relevant neural control, constraints imposed by sensorimotor and cognitive deficits and--particularly for SD--psychosocial consequences of chronic neurological disease.
This review summarizes the etiology, diagnosis and treatment of LUTD and SD in neurological patients.
LUTD may lead to serious health problems; both LUTD and SD significantly affect quality of life. Management of patients with spinal cord injury and dysraphism is undertaken in specialized centers according to established guidelines. Treatment of neurological patients with noncomplicated neurogenic LUTD or SD should preferentially be guided by a neurologist.
For rational treatment of urinary symptoms, an accurate assessment is mandatory; the bladder and the sphincter need to be defined as normal, over- or underactive. Urodynamic testing is the gold standard for functional diagnosis; assessment of residual urine and uroflow are the minimal requirements before considering management. Dysfunction of desire, arousal and orgasm (ejaculation) may be diagnosed by medical history and are amenable to counselling and treatment, which is--in the case of erectile dysfunction--evidence based. Further high-quality studies are necessary to test the best approaches for diagnosing and managing particular types of neurogenic LUTD and SD in the different neurological patient populations.
下尿路功能障碍（LUTD）和性功能障碍（SD）在神经科患者中很常见，这是由于影响相关神经控制的多种病变、感觉运动和认知缺陷所带来的限制，以及——特别是对于SD——慢性神经疾病的心理社会后果共同作用的结果。
本综述总结了神经科患者LUTD和SD的病因、诊断和治疗方法。
LUTD可能导致严重的健康问题；LUTD和SD都会显著影响生活质量。脊髓损伤和脊柱裂患者的管理在专门的中心按照既定指南进行。非复杂性神经源性LUTD或SD的神经科患者的治疗应优先由神经科医生指导。
为了合理治疗泌尿症状，必须进行准确的评估；膀胱和括约肌需要被定义为正常、过度活跃或活动不足。尿动力学检查是功能诊断的金标准；在考虑治疗之前，残余尿量和尿流率评估是最低要求。性欲、性唤起和性高潮（射精）功能障碍可通过病史诊断，并且适合进行咨询和治疗，对于勃起功能障碍而言，治疗是基于证据的。需要进一步的高质量研究来测试在不同神经科患者群体中诊断和管理特定类型神经源性LUTD和SD的最佳方法。
