Practice Guideline

. 2025 Apr;32(4):e70119.

doi: 10.1111/ene.70119.

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)

Jalesh N Panicker^{1

2}, Alessandra Fanciulli³, Magdalena Krbot Skoric⁴, Tamara Kaplan^{5

6}, Katina Aleksovska⁷, Ivan Adamec⁴, Marcio Augusto Averbeck^{8

9}, Nicole Campese³, Pietro Guaraldi¹⁰, Fabian Leys³, Jorge Moreno-Palacios¹¹, Sara Simeoni^{1

2}, Iva Stankovic¹², Sarah Wright¹, Amit Batla¹³, Bertil Blok¹⁴, Claire Hentzen¹⁵, Max Josef Hilz^{16

17}, Thomas M Kessler¹⁸, Helmut Madersbacher¹⁹, Kannan Rajasekharan Nair²⁰, Krishnan Padmakumari Sivaraman Nair²¹, Mahreen Pakzad²², Anne Pavy-Le Traon²³, Guy Peryer^{24

25}, Mikolaj Przydacz²⁶, Ryuji Sakakibara²⁷, Udit Saraf²⁸, Matthew Smith²⁹, Walter Struhal³⁰, Roland D Thijs^{31

32

33}, Katarina Ivana Tudor³⁴, Marcin Tutaj³⁵, David B Vodušek³⁶, Gregor Wenning³, Mario Habek⁴

Affiliations

¹ Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK.
² UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
³ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
⁴ Department of Neurology, Referral Center for the Demyelinating Diseases of the Central Nervous System and Referral Center for the Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia.
⁵ Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁶ Harvard Medical School, Boston, Massachusetts, USA.
⁷ European Academy of Neurology, Vienna, Austria.
⁸ Neuro-Urology at Moinhos de Vento Hospital (Johns Hopkins Affiliated), Porto Alegre, Brazil.
⁹ Department of Urology, Sao Lucas Hospital, PUCRS, Porto Alegre, Brazil.
¹⁰ IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
¹¹ Urology Department, UMAE Hospital de Especialidades CMN Siglo XXI, IMSS, Mexico City, Mexico.
¹² Neurology Clinic, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
¹³ Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK.
¹⁴ Department of Urology, Section Functional Neuro-Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
¹⁵ GRC 01, GREEN Group of Clinical REsEarch in Neurourology, Sorbonne University, AP-HP, Hôpital Tenon, Paris, France.
¹⁶ Department of Neurology, University Erlangen-Nuremberg, Erlangen, Germany.
¹⁷ Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
¹⁸ Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
¹⁹ Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
²⁰ Department of Urology, Amrita Institute of Medical Science, Cochin, Kerala, India.
²¹ Sheffield Teaching Hospitals NHS Foundation Trust, The University of Sheffield, Sheffield, UK.
²² University College Hospital, London, UK.
²³ Neurology Department, Reference Center for Multiple System Atrophy, University Hospital of Toulouse, Toulouse, France.
²⁴ Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
²⁵ NIHR Applied Research Collaboration, England, UK.
²⁶ Department of Urology, Jagiellonian University Medical College, Krakow, Poland.
²⁷ Neurology Clinic Tsudanuma & Dowakai Chiba Hospital, Funabashi, Chiba, Japan.
²⁸ Department of Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
²⁹ Aging and Movement Research Group, University of Bristol, Bristol, UK.
³⁰ Karl Landsteiner University of Health Sciences, Department of Neurology, University Hospital Tulln, Tulln, Austria.
³¹ Department of Neurology, University Medical Centre, Leiden, the Netherlands.
³² Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands.
³³ UCL Queen Square Institute of Neurology, University College London, London, UK.
³⁴ Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia.
³⁵ Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
³⁶ Division of Neurology, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.

PMID: 40208234
PMCID: PMC11984325
DOI: 10.1111/ene.70119

Practice Guideline

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)

Jalesh N Panicker et al. Eur J Neurol. 2025 Apr.

. 2025 Apr;32(4):e70119.

doi: 10.1111/ene.70119.

Authors

Affiliations

¹ Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK.
² UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
³ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
⁴ Department of Neurology, Referral Center for the Demyelinating Diseases of the Central Nervous System and Referral Center for the Autonomic Nervous System Disorders, University Hospital Center Zagreb, Zagreb, Croatia.
⁵ Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁶ Harvard Medical School, Boston, Massachusetts, USA.
⁷ European Academy of Neurology, Vienna, Austria.
⁸ Neuro-Urology at Moinhos de Vento Hospital (Johns Hopkins Affiliated), Porto Alegre, Brazil.
⁹ Department of Urology, Sao Lucas Hospital, PUCRS, Porto Alegre, Brazil.
¹⁰ IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
¹¹ Urology Department, UMAE Hospital de Especialidades CMN Siglo XXI, IMSS, Mexico City, Mexico.
¹² Neurology Clinic, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
¹³ Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK.
¹⁴ Department of Urology, Section Functional Neuro-Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
¹⁵ GRC 01, GREEN Group of Clinical REsEarch in Neurourology, Sorbonne University, AP-HP, Hôpital Tenon, Paris, France.
¹⁶ Department of Neurology, University Erlangen-Nuremberg, Erlangen, Germany.
¹⁷ Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
¹⁸ Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
¹⁹ Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
²⁰ Department of Urology, Amrita Institute of Medical Science, Cochin, Kerala, India.
²¹ Sheffield Teaching Hospitals NHS Foundation Trust, The University of Sheffield, Sheffield, UK.
²² University College Hospital, London, UK.
²³ Neurology Department, Reference Center for Multiple System Atrophy, University Hospital of Toulouse, Toulouse, France.
²⁴ Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
²⁵ NIHR Applied Research Collaboration, England, UK.
²⁶ Department of Urology, Jagiellonian University Medical College, Krakow, Poland.
²⁷ Neurology Clinic Tsudanuma & Dowakai Chiba Hospital, Funabashi, Chiba, Japan.
²⁸ Department of Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
²⁹ Aging and Movement Research Group, University of Bristol, Bristol, UK.
³⁰ Karl Landsteiner University of Health Sciences, Department of Neurology, University Hospital Tulln, Tulln, Austria.
³¹ Department of Neurology, University Medical Centre, Leiden, the Netherlands.
³² Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands.
³³ UCL Queen Square Institute of Neurology, University College London, London, UK.
³⁴ Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia.
³⁵ Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
³⁶ Division of Neurology, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.

PMID: 40208234
PMCID: PMC11984325
DOI: 10.1111/ene.70119

Erratum in

Correction to 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).
[No authors listed] [No authors listed] Eur J Neurol. 2025 May;32(5):e70205. doi: 10.1111/ene.70205. Eur J Neurol. 2025. PMID: 40364541 Free PMC article. No abstract available.

Abstract

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.

Keywords: guideline; neurogenic; sexual dysfunction; treatment; urinary dysfunction; urogenital.

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Conflict of interest statement

J.N.P.: Consultant (Idorsia, Coloplast, Medice), Speaker Honorarium (Coloplast, Wellspect), Royalties (Cambridge University Press). A.F.: Royalties from Springer Verlag, speaker fees, and honoraria from Theravance Biopharma, GE Health Care, Bial, CNSystems, Broadview Ventures, KABEG, Austrian Autonomic Society, Elsevier, International Parkinson Disease and Movement Disorders Society, Austrian Neurology Society, Austrian Autonomic Society, and research grants from the FWF‐Austrian Science Fund, Medical University of Innsbruck, US MSA Coalition, Dr. Johannes and Hertha Tuba Foundation, and Austrian Exchange Program, outside of the present work. M.K.S.: Participated as a clinical investigator and/or received speaker fees fromSanofi Genzyme, Merck, Novartis, and Roche. I.A.: Participated as a clinical investigator and/or received consultation and/or speaker fees from Biogen, Sanofi Genzyme, Merck, Novartis, Roche, and AstraZeneca. M.A.A.: Consultant (Coloplast), speaker honorarium (Medtronic, Coloplast, GSK, Boston Scientific). J.M.P.: Speaker Honorarium (Asofarma, Convatec). A.B.: Has received a speaker honorarium from Ipsen Pharma and receives royalties from the book “Understanding Parkinsonism” (Jaypee brothers 2017). B.B.: Consultant (Coloplast), Speaker Honorarium (Coloplast), Research Grant (Axonics). C.H.: Consultant: Convatec, BBraun. Speaker: IPSEN, Abbvie, Hollister Inc., Convatec. K.P.S.N.: Has led clinical trials on spasticity in M.S. for Celgene and GWS pharma and received royalties from Cambridge University Press. M.S.: Honoraria from Abbvie. R.D.T.: Lecture and consultancy fees from Medtronic, UCB, Theravarance, LivAssured, Zogenix, Novartis, and Arvelle, and grants from Medtronic and NewLife Wearables. M.T.: Works as a DBS (deep brain stimulation) consultant for Medtronic. M.H.: Participated as a clinical investigator and/or received consultation and/or speaker fees from: Biogen, Sanofi Genzyme, Merck, Novartis, Roche, Astra Zeneca, and received funding from the Croatian Science Foundation. T.K., K.A., P.G., N.C., F.L., S.S., I.S., S.W., M.J.H., T.M.K., H.M., K.R.N., A.P.L.T., M.P., G.P., M.P., R.S., U.S., W.S., K.I.T., D.B.V., and G.W.: None declared.

Figures

**FIGURE 1**
Flowchart outlining steps of guideline development. *Guidelines selected based on overall quality and practicality of recommendations. Guidelines and consensus statements were ranked according to quality (AGREE II domain 3 score of rigour of development), currency, and relevance to individuals with neurological disease: *Green*: High‐quality guidelines, pertaining to neurological patients; *Blue*: Moderate‐quality guidelines, pertaining to neurological patients + high‐quality guidelines, not pertaining to neurological patients; *Yellow*: Low‐quality guidelines, pertaining to neurological patients; *Orange*: Moderate/low‐quality guidelines, not pertaining to neurological patients; *Pink*: Systematic Reviews, pertaining to neurological patients; *Grey*: Systematic Reviews, not pertaining to neurological patients; *Red*: Other literature. LOE, level of evidence; PICO, population intervention comparison outcome.

**FIGURE 2**
Algorithm illustrating the assessment and treatment of urinary symptoms*. *Derived from NEUROGED recommendations, which are based on different levels of evidence. Refer to the manuscript for further details. MS, multiple sclerosis; PSA, prostate‐specific antigen; PVR, post‐void residual volume; SCI, spinal cord injury; UTI, urinary tract infection.

**FIGURE 3**
Algorithm illustrating the assessment and treatment of sexual symptoms*. *Derived from NEUROGED recommendations, which are based on different levels of evidence. Refer to the manuscript for further details.

See this image and copyright information in PMC

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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)

Affiliations

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)

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical