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Sexual function is recognized as an important factor determining quality of life and dysfunction in neurological patients may significantly add to the burden of their disease. Any disruption in the sexual response cycle results in sexual dysfunction (SD). Laboratory testing should be tailored according to patient symptoms and risk factors. Fasting glucose and lipid profile may be measured to assess atherosclerotic risk factors for erectile dysfunction (ED). Oral drugs should be considered as first-line therapy for neurogenic ED. There are fewer evidence-based therapeutic options for treatment of female SD. However it is an area of increasing interest and marketing of therapies by pharmaceutical companies. Therapies relate to treatment of sexual desire, arousal, orgasm and/or sexual pain. The term hypoactive sexual desire disorder (HSDD) is used to describe low sexual desire and distress, and many therapies aim to address this aspect of female sexual function.
There are a number of neurological diseases which have an effect on bowel function. This chapter provides an overview of gastrointestinal (GI) physiology, with reference to the hindgut and pelvic floor. It addresses the problems caused by common neurological diseases. The intra-abdominal GI tract is varied, and divided into the organs of stomach, small intestine and large intestine. Bowel dysfunction affects approximately 80% of those with spinal cord injury (SCI) and causes more of a problem than urinary and sexual dysfunction in a third of individuals with SCI. Neurological diseases such as SCI or MS frequently impair CNS control of the gut. The difference between the neural control systems for bowel and bladder is underlined by the differing effects of such diseases on the two systems. Supraconal SCI tends to cause difficulty with evacuation of feces in addition to fecal incontinence, but predominantly difficulty with urinary continence.
This chapter describes the different surgical procedures for managing a neurogenic bladder. The procedures include electrical stimulation, bladder and urethral reconstructive surgery, bladder outlet obstruction management and the treatment of stress urinary incontinence. Electrical stimulation to manage bladder dysfunction in patients with neurological disorders has been used since 1950. Electrical stimulation therapies include intravesical electrostimulation, sacral neuromodulation and sacral anterior root stimulation with selective sacral rhizotomy. Cutaneous continent diversions may be performed in neurological patients, mainly in the young myelomeningocele patient or those with spinal cord injury (SCI) who cannot perform clean intermittent self-catheterization (CISC) via the urethra because of congenital abnormalities, urethral pain, obesity, strictures or poor hand mobility. Finally, the chapter describes the suprapubic catheter (SPC), and sphincter surgery, which relieves bladder outlet obstruction due to external urethral sphincter contraction.
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