ABSTRACT
Diagnosis and management of benign prostatic hyperplasia (BPH) in neurologically impaired patients is challenging. The assumption that lower urinary tract symptoms (LUTS) in these patients are invariably due to the underlying neuropathology may result in inadequate treatment of BPH. For example, in multiple system atrophy (MSA), LUTS may be the first manifestation, seen significantly before the diagnosis is made. Physical examination should include a focused urologic assessment with examination of the prostate and neurologic system. It only arises in the patient with pathology between the pontine micturition center and the sacral micturition center. Examples include spinal cord injury, multiple sclerosis, spinal dysraphism, and transverse myelitis. Certainly, the modern understanding of diabetic cystopathy is a combination of impaired detrusor contractility leading to incomplete emptying but also elements of detrusor overactivity and increased sensation.
