Bladder and Sexual Dysfunction

Urinary incontinence may be the presenting symptom of a neurologic lesion or may be a later sequela of neurologic disease. Urinary retention is present when there is incomplete emptying of the bladder and can be acute or chronic. Urinary incontinence rarely requires an urgent workup except when there is an acute neurologic deficit. The workup includes a detailed history, physical exam, and appropriately selected diagnostics tests. A targeted physical exam takes only minutes to perform and generally gives most of the necessary information. This includes suprapubic palpation to detect bladder distension, a rectal exam to assess anal sphincter tone and sacral sensation, a bulbocavernosus reflex, a cough stress test, and a pelvic exam in women. A voiding diary, measurement of post-void residual volume (PVR), urinalysis and culture completes the initial workup, with urodynamics reserved for cases in which a definitive diagnosis cannot be made with the basic workup. Sexual dysfunction, including erectile dysfunction and anejaculation, are common in patients with neurologic disease. While oral phosphodiesterase inhibitors are highly efficacious for erectile dysfunction, the treatment of anejaculation requires urology referral for advanced sperm retrieval techniques.