title: [Lower urinary tract dysfunctions in parkinsonian syndromes: a review by the Neuro-Urology Comittee of the French Association of Urology].
abstract: BACKGROUND
  Lower urinary tract disorders (LUTD) are common in Parkinson's disease (PD) and other parkinsonian syndromes (PS). They are responsible for a significant morbidity and mortality and impair patients' quality of life. The therapeutic management of these LUTD requires to know how to distinguish the PD from other PS and their epidemiology and pathophysiology.
  
  
  OBJECTIVE
  To provide a diagnostic and therapeutic management of LUTD in patients with PS.
  
  
  METHODS
  A review of litterature using PubMed library was performed using the following keywords: Parkinson's disease, multiple system atrophy, lower urinary tract disorders, neurogenic bladder, overactive bladder, obstruction, anticholinergics, dopamine, prostate surgery.
  
  
  RESULTS
  Sometimes revealing the neurological disease, LUTD in PS raise a diagnostic problem because they occur at an age when various urogynecological disorders can be intricated with neurogenic bladder dysfunction. The differential diagnosis between PD and multiple system atrophy is important to know by the urologist. The distinction is based on the semiological analysis, the clinical response to dopaminergic therapy and the clinical outcome but also on data from urodynamic explorations. The therapeutic management of these LUTD cannot be easy due to the difficulty of use of some pharmacological treatments and the risk of deterioration after inappropriate surgery. The different treatments include the careful use of anticholinergics, posterior tibial nerve stimulation, deep thalamic stimulation and low-dose intradetrusor injections of botulinum toxin without approval. The decision to perform prostate surgery will be taken with caution after proving the bladder obstruction.
  
  
  CONCLUSIONS
  When analysing LUTD in PS, the urologist must know to question the initial diagnosis of PD. Treatments in order to reduce morbidity and mortality of these LUTD and to improve the quality of life of patients suffering from these degenerative diseases, will be proposed after multidisciplinary neuro-urologic concertation. The decision to perform prostate surgery must be taken with caution after proving sub-vesical obstruction.
authors.affiliation: Service d'urologie et de transplantation rénale, université Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France. veronique.phe@gmail.com
authors.forename: V
authors.initials: V
authors.lastname: Phé
authors.forename: R
authors.initials: R
authors.lastname: Caremel
authors.forename: S
authors.initials: S
authors.lastname: Bart
authors.forename: E
authors.initials: E
authors.lastname: Castel-Lacanal
authors.forename: M
authors.initials: M
authors.lastname: de Sèze
authors.forename: F
authors.initials: F
authors.lastname: Duchêne
authors.forename: A
authors.initials: A
authors.lastname: Even
authors.forename: X
authors.initials: X
authors.lastname: Gamé
authors.forename: M
authors.initials: M
authors.lastname: Loubat
authors.forename: M C
authors.initials: MC
authors.lastname: Scheiber Nogueira
authors.forename: G
authors.initials: G
authors.lastname: Karsenty
mesh_terms: D000465:Algorithms; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D020734:Parkinsonian Disorders / Q000150:complications