Weak detrusor contractility correlates with motor disorders in Parkinson's disease

Abstract

Limited attention has been paid to the relationship between urinary symptoms or urodynamic findings and motor disorders in Parkinson's disease (PD). We aimed to correlate pressure-flow urodynamic parameters with video-gait analysis parameters in PD. We recruited 41 patients with PD (25 men and 16 women; age, 70.6 ± 8.5 years; H & Y motor grading: 2 [range, 1-3]; disease duration: 4 years [range, 1-7]; taking levodopa 300 mg/day [range, 100-400]). All patients underwent pressure-flow urodynamics (parameters: first sensation, bladder capacity, detrusor overactivity [noted in 24 patients], and Watts factor [WF]) and video-gait analysis (parameters: time and number of strides for 5-m gait [simple task] and time for timed up and go [complex task]). Statistical analysis was made by Mann-Whitney's U-test for analyzing the relation between detrusor overactivity and gait as well as Spearman's rank-correlation coefficient test for analyzing the relation between the remaining parameters and gait. We found no relation between filling-phase urodynamics (detrusor overactivity, first sensation, and bladder capacity) and video-gait analysis parameters. By contrast, we found a significant relation between voiding-phase urodynamics (WF, reflecting detrusor power) and all three video-gait analysis parameters (reflecting lower-half bradykinesia and loss of postural reflex) in our PD patients (P < 0.01). The close relation between the WF and motor disorders in the present study suggests that, though clinically mild, a weak detrusor in PD might have a central origin. We should follow postvoid residual volume carefully in PD patients with advanced gait disorder, because postvoid residual volume might increase in such patients.

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

“…Voiding phase urodynamic studies show detrusor weakness in 66% of woman and 40% of men with PD [36]. Weak detrusor activity during voiding has been shown to correlate with motor disorders [40]. Detrusor-external sphincter dyssynergia in which detrusor contraction is concurrent with involuntary urethral contraction is rare in PD with a reported prevalence of 0e3% [36,37].…”

The PRIAMO study: urinary dysfunction as a marker of disease progression in early Parkinson's disease

“…Urinary symptoms (US) in PD include nocturia, urgency, frequency, incontinence and difficulty in voiding, all attributable to bladder overactivity and thought to reflect an alteration in frontalbasal ganglia circuits that normally suppress the micturition reflex [2][3][4][5]. US may occur from the premotor phase of PD and are associated with higher motor disability, more severe dopaminergic denervation and poorer quality of life [6][7][8][9][10][11].…”

Therapeutic efficacy of low‐dose (25 mg) mirabegron therapy for patients with mild to moderate overactive bladder symptoms due to central nervous system diseases

“…The pathogenesis of OAB in patients with cerebral events involves not only sensory perception, but also impaired detrusor contractility. Patients with CVA or PD may also have impaired detrusor contractility in addition to detrusor overactivity (DO), which may increase PVR …”