European Society of Neuro-Urology (ESNU

The ESNU was founded in 1999 as the European Studygroup on Neurourology. In 2000 the name was changed to ESNU.
In 2006 the board has updated the mission and aims of the society.

Mission
The scope for the European Society for Neurourology goes from receptor to function for urological problems in neurological conditions and neurological problems in urological conditions.
The most important aims are:

• To stimulate basis and clinical scientific research on signal transduction and neurotransmission in the urogenital tract
  - pharmacological and (patho)-physiological research
  - electrophysiological research
• To stimulate scientific and clinical training and education in neuro-urology by:
  - forming an international network of centres of excellence
  - designing scholarship programs
  - organising international meetings
  - by closer collaboration with the ESU
  - publishing guidelines
• To have a solid and ethical collaboration with the industry
  - by facilitating multicentre trials
  - advisory functions

The ESNU wants to establish neurourology as one of the subspecialities in urology. Education and training have the highest priority. The ESNU will ensure specialised training programs in collaboration with other EAU sections in the coming years.

Background
Neurourology has long been neglected as subspecialty within urology and neurology. In recent years the field has evolved since new diagnostic techniques and therapeutic options have become available to treat patients with urological problems in neurological conditions.

Neurogenic Lower Urinary Tract Dysfunction still is a diagnostic challenge for each urologist confronted with this problem.
Based on a sound urodynamic investigation the urologist will have to characterize the funcional disorder of storage and / or voiding function and he will try to exclude other frequent and serious etiologies of the patient's symptoms such as infection, BPH, PCA or TCC. Particularly if elderly male patients are affected, differential diagnosis between BPH and neurogenic causes of lower urinary tract symptoms may become difficult if not impossible. This may become of significant importance if an invasive surgical treatment like TUR-P for instance is considered, since the outcome will be less favourable in the presence of an underlying neurological disease. Test results from urodynamic or imaging investigation may also supply informations about the potential location or even cause of a neurological lesion, sometimes allowing a causal treatment of the underlying neurological disease.

Treatment of neurogenic lower urinary tract dysfunction includes pharmacotherapy, external electrical stimulation, instrumental drainage of the bladder and surgical treatment options like sacral neuromodulation, sacral anterior root stimulation / sacral deafferentation, the use of botulinum toxin, augmentation cystoplasty or even urinary diversion. Depending on the individual problem in general conservative treatment will be applied before proceeding to more invasive types of therapy.

Neurourologist often work in collaboration with other specialties and need to be open to a multidisciplinary approach. They will take care of young adults with a neurogenic bladders, who were once followed by pediatricians and pediatric urologists. They will deal with spinal cord injured patients, MS patients or patients referred by others specialties and they will often be active in rehabilitation centres. An open mind an good communicative skills are essentiam to achieve success in this multidisciplinary environment.