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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="review-article" dtd-version="1.2" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">Bulletin of Rehabilitation Medicine</journal-id><journal-title-group><journal-title xml:lang="en">Bulletin of Rehabilitation Medicine</journal-title><trans-title-group xml:lang="ru"><trans-title>Вестник восстановительной медицины</trans-title></trans-title-group></journal-title-group><issn publication-format="print">2078-1962</issn><issn publication-format="electronic">2713-2625</issn><publisher><publisher-name xml:lang="en">National Medical Research Center for Rehabilitation and Balneology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">687251</article-id><article-id pub-id-type="doi">10.38025/2078-1962-2026-25-1-84-95</article-id><article-categories><subj-group subj-group-type="toc-heading" xml:lang="en"><subject>Articles</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="ru"><subject>Статьи</subject></subj-group><subj-group subj-group-type="article-type"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title xml:lang="en">Various approaches to the diagnosis and management of neurogenic urogenital symptoms in neurological patients: a review of international and Russian guidelines</article-title><trans-title-group xml:lang="ru"><trans-title>Различные подходы к диагностике и лечению урогенитальных симптомов у неврологических пациентов: обзор международных и российских рекомендаций</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5256-8410</contrib-id><name-alternatives><name xml:lang="en"><surname>Bershadskii</surname><given-names>Artem V.</given-names></name><name xml:lang="ru"><surname>Бершадский</surname><given-names>Артем Валерьевич</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Ph.D. (Med.), Urologist, Medical Rehabilitation Center</p></bio><bio xml:lang="ru"><p>кандидат медицинских наук, врач-уролог, центр медицинской реабилитации</p></bio><email>natsia@gmail.com</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7128-6400</contrib-id><name-alternatives><name xml:lang="en"><surname>Salyukov</surname><given-names>Roman V.</given-names></name><name xml:lang="ru"><surname>Салюков</surname><given-names>Роман Вячеславович</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>D.Sc. (Med.), Professor at the Department of Urology with Courses in Oncology, Radiology, and Andrology, Faculty of Postgraduate Education</p></bio><bio xml:lang="ru"><p>доктор медицинских наук, профессор кафедры урологии с курсами онкологии, радиологии и андрологии</p></bio><email>natsia@gmail.com</email><xref ref-type="aff" rid="aff2"/><xref ref-type="aff" rid="aff3"/><xref ref-type="aff" rid="aff4"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1652-2925</contrib-id><name-alternatives><name xml:lang="en"><surname>Luzanova</surname><given-names>Ekaterina I.</given-names></name><name xml:lang="ru"><surname>Лузанова</surname><given-names>Екатерина Игоревна</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Ph.D. (Med.), Associate Professor at the Department of Nervous Diseases</p></bio><bio xml:lang="ru"><p>кандидат медицинских наук, доцент кафедры нервных болезней</p></bio><email>natsia@gmail.com</email><xref ref-type="aff" rid="aff5"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0544-1492</contrib-id><name-alternatives><name xml:lang="en"><surname>Belkin</surname><given-names>Andrey A.</given-names></name><name xml:lang="ru"><surname>Белкин</surname><given-names>Андрей Августович</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>D.Sc. (Med.), Professor at the Departments of Nervous Diseases and Anesthesiology-Resuscitation</p></bio><bio xml:lang="ru"><p>доктор медицинских наук, профессор кафедр нервных болезней и анестезиологии-реаниматологии</p></bio><email>natsia@gmail.com</email><xref ref-type="aff" rid="aff6"/></contrib></contrib-group><aff-alternatives id="aff1"><aff><institution xml:lang="en">Brain Institute Clinic LLC</institution></aff><aff><institution xml:lang="ru">ООО «Клиника Института Мозга»</institution></aff></aff-alternatives><aff-alternatives id="aff2"><aff><institution xml:lang="en">Peoples' Friendship University of Russia</institution></aff><aff><institution xml:lang="ru">Российский университет дружбы народов</institution></aff></aff-alternatives><aff-alternatives id="aff3"><aff><institution xml:lang="en">Pirogov Russian National Research Medical University</institution></aff><aff><institution xml:lang="ru">Российский национальный исследовательский медицинский университет имени Н.И. Пирогова Минздрава России (Пироговский Университет)</institution></aff></aff-alternatives><aff-alternatives id="aff4"><aff><institution xml:lang="en">Russian Scientific Center of Roentgenology and Radiology</institution></aff><aff><institution xml:lang="ru">Российский научный центр рентгенорадиологии Минздрава России</institution></aff></aff-alternatives><aff-alternatives id="aff5"><aff><institution xml:lang="en">South Ural State Medical University</institution></aff><aff><institution xml:lang="ru">Южно-Уральский государственный медицинский университет Минздрава России</institution></aff></aff-alternatives><aff-alternatives id="aff6"><aff><institution xml:lang="en">Ural State Medical Academy</institution></aff><aff><institution xml:lang="ru">Уральский государственный медицинский университет Минздрава России</institution></aff></aff-alternatives><pub-date date-type="pub" iso-8601-date="2026-02-25" publication-format="electronic"><day>25</day><month>02</month><year>2026</year></pub-date><volume>25</volume><issue>1</issue><issue-title xml:lang="en"/><issue-title xml:lang="ru"/><fpage>84</fpage><lpage>95</lpage><history><date date-type="received" iso-8601-date="2025-07-10"><day>10</day><month>07</month><year>2025</year></date><date date-type="accepted" iso-8601-date="2025-11-15"><day>15</day><month>11</month><year>2025</year></date></history><permissions><copyright-statement xml:lang="en">Copyright ©; 2026, Bershadskii A.V., Salyukov R.V., Luzanova E.I., Belkin A.A.</copyright-statement><copyright-statement xml:lang="ru">Copyright ©; 2026, Бершадский А.В., Салюков Р.В., Лузанова Е.И., Белкин А.А.</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="en">Bershadskii A.V., Salyukov R.V., Luzanova E.I., Belkin A.A.</copyright-holder><copyright-holder xml:lang="ru">Бершадский А.В., Салюков Р.В., Лузанова Е.И., Белкин А.А.</copyright-holder><ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/"/><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by/4.0</ali:license_ref></license></permissions><self-uri xlink:href="https://journals.eco-vector.com/2078-1962/article/view/687251">https://journals.eco-vector.com/2078-1962/article/view/687251</self-uri><abstract xml:lang="en"><p><bold>INTRODUCTION. </bold>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).</p> <p><bold>AIM. </bold>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.</p> <p><bold>MATERIALS AND METHODS. </bold>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.</p> <p><bold>RESULTS. </bold>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.</p> <p><bold>DISCUSSION. </bold>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.</p> <p><bold>CONCLUSION. </bold>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.</p></abstract><trans-abstract xml:lang="ru"><p><bold>ВВЕДЕНИЕ.</bold> Урогенитальные симптомы, включая нейрогенные нарушения мочеиспускания и сексуальные дисфункции, являются частыми и значимыми проявлениями неврологических заболеваний. Однако в клинической практике неврологов и специалистов по медицинской реабилитации отсутствуют унифицированные алгоритмы диагностики и лечения этих расстройств. В 2025 г. был опубликован мультидисциплинарный международный документ — NEUROGED Guidelines, разработанный Европейской академией неврологии (European Academy of Neurology — EAN), Европейской федерацией автономных расстройств (European Federation of Autonomic Societies — EFAS) и Международным нейроурологическим обществом (International Neuro-Urology Society — INUS).</p> <p><bold>ЦЕЛЬ.</bold> Представить обзор рекомендаций NEUROGED и провести их сравнительный анализ с отечественными клиническими рекомендациями по неврологическим нозологиям и нейрогенной дисфункции нижних мочевыводящих путей с оценкой применимости в российской практике.</p> <p><bold>МАТЕРИАЛЫ И МЕТОДЫ.</bold> С сентября по ноябрь 2025 г. проведен структурный анализ руководства NEUROGED (2025) с точки зрения состава, доказательной базы и алгоритмов ведения. Рекомендации NEUROGED включают 38 клинических положений, охватывающих диагностику и лечение урологических и сексуальных симптомов. Выполнено сопоставление с рекомендациями Российского общества урологов (РОУ, 2025) и других профессиональных ассоциаций, одобренных Научно-практическим советом Минздрава России. Анализ проведен врачами-экспертами: урологом, неврологом и врачом физической и реабилитационной медицины.</p> <p><bold>РЕЗУЛЬТАТЫ. </bold>По результатам анализа показано, что рекомендации NEUROGED представляют системный, стратифицированный по «красным флагам» подход к диагностике и лечению нейрогенных урогенитальных и сексуальных симптомов у неврологических пациентов с акцентом на поведенческую терапию, нейростимуляцию, приоритет периодической катетеризации и включение сексуальной реабилитации в стандарт ведения. В то же время выявлена фрагментарность и неоднородность отечественных клинических рекомендаций, в которых недостаточно отражены вопросы сексуальной дисфункции, немедикаментозной терапии, роли невролога и врача реабилитационной медицины в маршрутизации пациентов, что обосновывает целесообразность адаптации ключевых положений NEUROGED для российской практики.</p> <p><bold>ОБСУЖДЕНИЕ.</bold> В отличие от протокола РОУ, NEUROGED предлагает более гибкий, стратифицированный подход на основе клинических «красных флагов», акцентирует роль поведенческой терапии, нейростимуляции, сексуальной реабилитации и первичной маршрутизации неврологом. Российские рекомендации в свою очередь демонстрируют высокую детализацию урологических аспектов, но практически не затрагивают вопросы сексуального здоровья, поведенческих стратегий и мультидисциплинарного взаимодействия.</p> <p><bold>ЗАКЛЮЧЕНИЕ.</bold> NEUROGED представляет собой клинически адаптируемую модель ведения урогенитальных расстройств у пациентов с неврологическими заболеваниями. Внедрение ключевых положений NEUROGED особенно актуально в условиях дефицита нейроурологических кадров и ограниченного доступа к узкоспециализированной помощи. Целесообразно усилить обучение неврологов в сфере нейроурологии, так как нейрогенная дисфункция нижних мочевых путей может быть рассмотрена как проявление очаговой неврологической симптоматики, и невролог — это первый специалист, который способен заподозрить, диагностировать и маршрутизировать пациента с целью улучшения качества медицинской помощи и профилактики осложнений.</p></trans-abstract><kwd-group xml:lang="en"><kwd>neurogenic lower urinary tract dysfunction</kwd><kwd>sexual dysfunction</kwd><kwd>neurological diseases</kwd><kwd>NEUROGED</kwd><kwd>clinical guidelines</kwd><kwd>neuro-urology</kwd><kwd>behavioral therapy</kwd><kwd>intermittent catheterization</kwd><kwd>multidisciplinary approach</kwd><kwd>stroke</kwd><kwd>multiple sclerosis</kwd><kwd>Parkinson’s disease</kwd></kwd-group><kwd-group xml:lang="ru"><kwd>нейрогенная дисфункция нижних мочевых путей</kwd><kwd>сексуальная дисфункция</kwd><kwd>неврологические заболевания</kwd><kwd>NEUROGED</kwd><kwd>клинические рекомендации</kwd><kwd>нейроурология</kwd><kwd>поведенческая терапия</kwd><kwd>периодическая катетеризация</kwd><kwd>мультидисциплинарный подход</kwd><kwd>инсульт</kwd><kwd>рассеянный склероз</kwd><kwd>болезнь Паркинсона</kwd></kwd-group><funding-group/></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><mixed-citation>Bershadsky A., Belkin A., Salyukov R. 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