Urogenital Dysfunction in Neurological Diseases

Review maps how neural damage from cortex to ganglia produces distinct bladder and sexual dysfunction across 10+ neurological conditions

Journal: Nature Reviews Neurology | Published: 2026-04-02 | Type: Narrative Review | PMID: 41927939 Authors: Sakakibara Ryuji (Dowakai Chiba Hospital and Neurology Clinic Tsudanuma, Japan), Yamamoto Tatsuya (Chiba Prefectural University of Health Sciences), Uchiyama Tomoyuki (Shioya Hospital, International University of Health and Welfare) Funding/COI: Funding not disclosed; authors declare no competing interests

Summary

Three Japanese neurologists with subspecialty expertise in voiding dysfunction survey the neural circuitry governing the lower urinary tract and sexual organs, then trace how lesions at each level of the neuraxis — cortex, brainstem, spinal cord, peripheral ganglia — produce distinct dysfunction patterns. Conditions covered include 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. The review provides no primary data; it synthesizes existing literature and addresses management approaches.

Claims

• Neural damage at any neuraxis level can produce urogenital dysfunction involving the lower urinary tract and/or sexual organs
• Lower urinary tract dysfunction manifests as either underactive bladder (urinary retention) or overactive bladder (urinary incontinence)
• Sexual dysfunction in neurological disease encompasses loss of libido and impairment of erection, ejaculation, and orgasm
• The voiding reflex operates via a spinobulbospinal pathway through the periaqueductal gray (PAG) and pontine micturition center (PMC) in an all-or-none, switch-like manner
• Acetylcholine and ATP act as co-excitatory transmitters in the bladder; nitric oxide is the inhibitory transmitter in the urethra; norepinephrine plays dual excitatory/inhibitory roles depending on bladder region

Study Quality

This is a narrative review, not a systematic review or meta-analysis. No search methodology, inclusion criteria, PRISMA framework, or risk-of-bias assessment is reported in the available sections. Study selection therefore reflects author expertise and familiarity rather than a reproducible literature search — a meaningful limitation when claims about management advances are made across ten conditions simultaneously.

The conclusion section provided reads primarily as a neurophysiology textbook summary rather than a synthesis of recent clinical evidence, heavy on receptor pharmacology and neural circuit anatomy. Publication in Nature Reviews Neurology implies editorial and peer review, but the journal's prestige is not a substitute for stated methodology.

Red Flags

• No funding source disclosed — atypical for a Nature Reviews article and prevents COI assessment beyond author self-declaration
• Narrative design with no stated search strategy or inclusion criteria: subject to selection bias
• No quantitative synthesis: no effect sizes, pooled estimates, or forest plots
• Covers 10+ distinct neurological conditions in a single paper — breadth likely sacrifices depth for any individual condition
• Full text unavailable for complete assessment; the conclusion excerpt is weighted toward basic neuroscience over clinical outcome data

Strengths

• Published in a high-impact, peer-reviewed journal with international reach
• No declared conflicts of interest
• Addresses an underserved intersection: urogenital consequences of neurological disease are routinely under-recognized in both neurology and urology practice
• Covers both lower urinary tract and sexual dysfunction together, which most reviews treat separately
• Authored by neurologists with demonstrated subspecialty focus on voiding dysfunction

Verdict

This is a reference-level orientation, not a study to cite for specific treatment effect sizes. Its utility is giving clinicians and researchers a single map of how neurological disease disrupts urogenital function across the neuraxis — not delivering new clinical data. Without a stated search methodology it cannot be treated as a systematic review, and the ten-condition scope makes it difficult to extract actionable depth on any single diagnosis. Worth reading as background; cite with caution for anything more specific than "neurological disease affects bladder and sexual function."