Lower urinary tract symptoms in Parkinson's disease: Prevalence, aetiology and management

Abstract

Lower urinary tract symptoms (LUTS) are common in Parkinson's disease (PD), effecting 27-85% of patients with PD. Irritative symptoms predominate and urodynamic studies confirm high prevalence of detrusor overactivity in PD. LUTS are present early in PD and are more common in PD than in age matched controls. The assessment of LUTS in PD is complicated by coexisting bradykinesia and cognitive impairment. Although LUTS become more troublesome as PD progresses it remains unclear if LUTS severity correlates with motor symptoms and/or duration of PD. The underlying cause of LUTS in PD remains to be fully elucidated. Animal and human studies suggest the net effect of the basal ganglia is to supress micturition. Although LUTS are a common in PD, few studies have examined the assessment and management of LUTS specifically in patients with PD. Pilot studies have suggested that bladder training, antimuscarinic drugs and intravesical botulinum toxin maybe helpful but these trials have been small and frequently lacked a suitable control group making them vulnerable to the placebo effect. Furthermore the adverse effects of antimuscarinic drugs on cognitive and gastrointestinal function may limit the use of these drugs in PD. In this review we summarise the literature describing the prevalence of LUTS in PD, discuss the emerging data delineating the underlying pathophysiology of LUTS and examine interventions helpful in the management of LUTS in people with PD.

The clinical features and outcome of scan-negative and scan-positive cases in suspected cauda equina syndrome: a retrospective study of 276 patients

“…However, as in previous studies, no individual clinical symptom or sign could accurately differentiate between scan-positive and ‘scan-negative’ CES [7]. The explanation for scan-negative CES does not appear to be latent neurological disease, of which there are many causes (Table 4) [8–19], at least in the majority of patients, since we only found one patient where this was the case at follow-up.…”

Behavioral therapy for urinary symptoms in Parkinson's disease: A randomized clinical trial

“…The pathogenesis of urinary symptoms in Parkinson's disease is hypothesized to be affected by two pathways involved in the underlying pathophysiology of the disease. Loss of dopaminergic balance in the basal ganglia leads to a loss of inhibition of bladder contractility through the pontine micturition center resulting in more frequent involuntary bladder contractions . Additionally, cortical α‐synuclein pathology may impact integration of sensory input from the bladder to the cortex leading to loss of recognition of bladder fullness and lack of advanced planning for the need to void (executive dysfunction) .…”

“…While Parkinson's disease is often characterized by motor symptoms (tremor, bradykinesia, and rigidity), nonmotor symptoms, including urinary symptoms, correlate more closely with impaired well‐being as the disease progresses . Overactive bladder (OAB) symptoms, including urgency, frequency, and nocturia, with or without urgency urinary incontinence, are the most common urinary symptoms of Parkinson's disease . Because OAB symptoms, such as urgency incontinence and nocturia, are associated with falls (a cause of increased mortality in Parkinson's disease), spouse/caregiver stress, and, ultimately institutionalization, it is critical that we provide efficacious therapy for the treatment of urinary symptoms in persons with Parkinson's disease.…”

A critical appraisal of the principal guidelines for neurogenic lower urinary tract dysfunction using the AGREE II instrument

“…Neurogenic lower urinary tract dysfunction (NLUTD) is a urological dysfunction that occurs as a consequence of neurologic disease. It affects approximately 27‐85% of patients with Parkinson's disease (PD), 70‐84% with spinal cord injuries (SCI), up to 70% of those with stroke, and 40‐90% of persons with multiple sclerosis (MS) . Individuals with NLUTD may experience neurogenic detrusor overactivity (NDO), which is characterized by increased frequency of micturition, urinary urgency (if sensation is unaffected by the underlying condition) and urinary incontinence.…”

“…40-90% of persons with multiple sclerosis (MS). [1][2][3] Individuals with NLUTD may experience neurogenic detrusor overactivity (NDO), which is characterized by increased frequency of micturition, urinary urgency (if sensation is unaffected by the underlying condition) and urinary incontinence. Alternatively, patients may have problems in voiding, with symptoms including hesitancy, a slow urinary stream, the need to strain, and urinary retention.…”