Various approaches to the diagnosis and management of neurogenic urogenital symptoms in neurological patients: a review of international and Russian guidelines

INTRODUCTION. Urogenital symptoms, including neurogenic voiding disorders and sexual dysfunctions, are frequent and clinically significant manifestations of neurological diseases. However, in the everyday practice of neurologists and medical rehabilitation specialists, there are no unified algorithms for the diagnosis and management of these conditions. In 2025, a multidisciplinary international document, the NEUROGED Guidelines, was published, developed by the European Academy of Neurology (EAN), the European Federation of Autonomic Societies (EFAS), and the International Neuro-Urology Society (INUS). AIM. To present an overview of the NEUROGED recommendations and to perform a comparative analysis with domestic clinical guidelines on neurological nosologies and neurogenic lower urinary tract dysfunction, assessing their applicability in Russian clinical practice. MATERIALS AND METHODS. From September to November 2025, a structural analysis of the NEUROGED Guidelines (2025) was performed with regard to their composition, evidence base, and management algorithms. The NEUROGED recommendations comprise 38 clinical statements covering the diagnosis and treatment of urological and sexual symptoms. A comparison was conducted with the recommendations of the Russian Society of Urologists (RSU, 2025) and other professional associations approved by the Scientific and Practical Council of the Ministry of Health of Russia. The analysis was carried out by expert physicians: a urologist, a neurologist, and a physician specializing in physical and rehabilitation medicine. RESULTS. The analysis demonstrated that the NEUROGED recommendations provide a systematic, “red flag” — stratified approach to the diagnosis and management of neurogenic urogenital and sexual symptoms in neurological patients, with a focus on behavioral therapy, neuromodulation, prioritization of intermittent catheterization, and incorporation of sexual rehabilitation into the standard of care. At the same time, the existing Russian clinical guidelines were found to be fragmented and heterogeneous, with insufficient coverage of sexual dysfunction, non-pharmacological interventions, and the roles of neurologists and rehabilitation medicine physicians in patient routing, thereby supporting the need to adapt key NEUROGED provisions for Russian clinical practice. DISCUSSION. In contrast to the RSU protocol, the NEUROGED guidelines propose a more flexible, stratified approach based on clinical “red flags”, emphasizing the role of behavioral therapy, neuromodulation, sexual rehabilitation, and initial routing by the neurologist. Russian guidelines, in turn, provide a high level of detail regarding urological aspects but virtually do not address issues of sexual health, behavioral strategies, or multidisciplinary collaboration. CONCLUSION. NEUROGED represents a clinically adaptable model for the management of urogenital disorders in patients with neurological diseases. The implementation of its key provisions is particularly relevant in the context of a shortage of neuro-urology specialists and limited access to highly specialized care. It is advisable to enhance neurologists’ training in neuro-urology, since neurogenic lower urinary tract dysfunction may be regarded as a manifestation of focal neurological symptomatology, and the neurologist is the first specialist able to suspect, diagnose, and appropriately route the patient in order to improve the quality of medical care and prevent complications.