Abstract
AIMS: After presentation with urinary symptoms, an underlying neurological mechanism sometimes emerges subsequently. Increased awareness may bring earlier diagnosis, improving prognosis and outcomes. METHODS: A 2024 International Consultation on Incontinence Research Society think-tank considered the clinical pathway for identification of an undiagnosed neurological or autonomic contribution precipitating urinary symptoms, and the implications for prognosis. RESULTS: Alongside adult-onset neurogenic conditions, potential for missed diagnosis includes congenital and pediatric-acquired neurogenic conditions, which may become symptomatic during a growth spurt due to spinal cord tethering. Detailed assessment is needed, also considering bowel and sexual dysfunction, with timely referral to neurology to reduce preventable progression of disease. In neurological assessment, control of micturition is often poorly characterized compared with other aspects of spinal cord function and the cranial nerves. Screening tools may be used to identify people who have increased likelihood of particular conditions, but currently available tools are either single-system or population specific. In addition to the general pelvic examination, the assessment of sacral reflexes and pelvic sensations can suggest a neurological mechanism, though the sensitivity and specificity of the neuro-urological examination is unknown. Including the results of the neuro-perineal examination in the urodynamic report may improve the interpretation of the results and potentially support a neurological aetiology. CONCLUSION: Future research should consider the value of neuro-urological examination in diagnosis of occult neurological disease, the development of an occult neurology screening tool/risk scoring based on pelvic organ symptoms, and appropriateness of non-neurologist practitioners requesting neurological investigations such as MRI scanning. CLINICAL TRIAL REGISTRATION: Does not apply.