Urogenital dysfunction in neurological diseases

Neural damage at any level of the neuraxis can lead to urogenital dysfunction, involving the lower urinary tract (LUT) and/or the sexual organs. The LUT consists of the bladder and the urethra (plus the prostate in males); LUT dysfunction can manifest as an underactive bladder, leading to urinary retention, or as an overactive bladder, leading to urinary incontinence. Manifestations of sexual dysfunction include loss of libido and dysfunction of erection, ejaculation and orgasm. In this Review, we address the physiology and innervation of the LUT and the sexual organs and discuss various aspects of urogenital dysfunction in CNS (brain and spinal cord) disorders including stroke, Alzheimer disease, white matter disease, normal-pressure hydrocephalus, Parkinson disease, dementia with Lewy bodies, multiple system atrophy, spinal cord injury, multiple sclerosis and spina bifida. We also review advances in the management of urogenital dysfunction in patients with neurological disorders.