PLYMOUTH, UK — Clinicians should be aware that underlying—and undiagnosed—neurological conditions could be involved in lower urinary tract symptoms (LUTS).

That’s according to a report in the journal Neurology Urodynamics. An international study led by researchers from Derriford Hospital in the UK and including participation from the8 VA Palo Alto, CA, Health Care System pointed out that LUTS are a common urological referral and sometimes can have a neurological basis in a patient with no formally diagnosed neurological disease, which is called “occult neurology.”1

“Early identification and specialist input is needed to avoid bad LUTS outcomes, and to initiate suitable neurological management,” the study team advised.

To reach those conclusions, the International Continence Society established a neurological working group to consider the following questions: Which neurological conditions may include LUTS as an early feature and what diagnostic evaluations should be undertaken in the LUTS clinic?

The shortlist of conditions was drawn up by expert consensus and discussed at the annual congress of the International Neuro-Urology Society. Recommendations for identifying clinical features and management then were generated.

Determined to be relevant conditions were:

  • multiple sclerosis,

  • multiple system atrophy,

  • normal pressure hydrocephalus,

  • early dementia,

  • Parkinsonian syndromes (including early Parkinson’s Disease and Multiple System Atrophy) and

  • spinal cord disorders (including spina bifida occulta with tethered cord and spinal stenosis).

Researchers recommended that, in LUTS clinics, clinicians need to identify additional atypical features, including new onset severe LUTS (excluding infection), unusual aspects (e.g., enuresis without chronic retention) or “suspicious” symptoms (e.g., numbness, weakness, speech disturbance, gait disturbance, memory loss/cognitive impairment and autonomic symptoms).

“Where occult neurology is suspected, healthcare professionals need to undertake early appropriate referral; central nervous system imaging booked from LUTS clinic is not recommended,” the authors wrote.

Researchers concluded that occult neurology is an uncommon underlying cause of LUTS but urged prompt intervention if suspected and the establishment of suitable management pathways.


  1. Roy HA, Nettleton J, Blain C, et al. Assessment of patients with lower urinary tract symptoms where an undiagnosed neurological disease is suspected: A report from an International Continence Society consensus working group [published online ahead of print, 2020 Aug 4]. Neurourol Urodyn. 2020;10.1002/nau.24469. doi:10.1002/nau.24469