title: A guideline for the management of bladder dysfunction in Parkinson's disease and other gait disorders.
abstract: Parkinson's disease (PD) is a common neurodegenerative disorder, and lower urinary tract (LUT) dysfunction is one of the most common autonomic disorders with an estimated incidence rate of 27-80%. Studies have shown that bladder dysfunction significantly influences quality-of-life (QOL) measures, early institutionalisation, and health economics. We review the pathophysiology of bladder dysfunction in PD, lower urinary tract symptoms (LUTS), objective assessment, and treatment options. In patients with PD, disruption of the dopamine D1-GABAergic direct pathway may lead to LUTS. Overactive bladder (OAB) is the most common LUT symptom in PD patients, and an objective assessment using urodynamics commonly shows detrusor overactivity (DO) in these patients. The post-void residual (PVR) volume is minimal in PD, which differs significantly from multiple system atrophy (MSA) patients who have a more progressive disease that leads to urinary retention. However, subclinical detrusor weakness during voiding may also occur in PD. Regarding bladder management, there are no large, double-blind, prospective studies in this area. It is well recognised that dopaminergic drugs can improve or worsen LUTS in PD patients. Therefore, an add-on therapy with anticholinergics is required. Beta-3 adrenergic agonists are a potential treatment option because there are little to no central cognitive events. Newer interventions, such as deep brain stimulation (DBS), are expected to improve bladder dysfunction in PD. Botulinum toxin injections can be used to treat intractable urinary incontinence in PD. Transurethral resection of the prostate gland (TURP) for comorbid BPH in PD is now recognised to be not contraindicated if MSA is excluded. Collaboration of urologists with neurologists is highly recommended to maximise a patients' bladder-associated QOL. Neurourol. Urodynam. 35:551-563, 2016. © 2015 Wiley Periodicals, Inc.
authors: Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan.
authors: Ryuji
authors: R
authors: Sakakibara
authors: Neurology, National Hospital for Neurology & Neurosurgery, London, United Kingdom.
authors: Jalesh
authors: J
authors: Panicker
authors: Department of Experimental Medicine and Surgery, Tor Vergata University and Unit for Functional Urology, Policlinico Tor Vergata University Hospital, Rome, Italy.
authors: Enrico
authors: E
authors: Finazzi-Agro
authors: School of Specialization in Urology, Tor Vergata University Unit for Functional Urology, Policlinico Tor Vergata University Hospital, Rome, Italy.
authors: Valerio
authors: V
authors: Iacovelli
authors: Urology, University of Sao Paulo, Brazil.
authors: Homero
authors: H
authors: Bruschini
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use; D001921:Brain / Q000378:metabolism / Q000503:physiopathology; D046690:Deep Brain Stimulation; D004298:Dopamine / Q000378:metabolism; D020233:Gait Disorders, Neurologic / Q000150:complications / Q000503:physiopathology; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D010300:Parkinson Disease / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D001743:Urinary Bladder / Q000503:physiopathology*; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000503:physiopathology*; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology*; D014563:Urodynamics
chemical_list: D000978:Antiparkinson Agents; D004298:Dopamine
keywords: Parkinson's disease; guideline; management; oveactive bladder; quality of life