title: Genitourinary dysfunction in Parkinson's disease.
abstract: Bladder dysfunction (urinary urgency/frequency) and sexual dysfunction (erectile dysfunction) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, genitourinary autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the genitourinary dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life.
authors.affiliation: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Shimoshizu, Sakura 285-8741, Japan. sakakibara@sakura.med.toho-u.ac.jp
authors.forename: Ryuji
authors.initials: R
authors.lastname: Sakakibara
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamanishi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kishi
mesh_terms: D001479:Basal Ganglia / Q000503:physiopathology; D007172:Erectile Dysfunction / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009434:Neural Pathways / Q000503:physiopathology; D010300:Parkinson Disease / Q000150:complications*; D001745:Urinary Bladder Diseases / Q000209:etiology* / Q000473:pathology / Q000628:therapy