title: 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.
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. Electronic address: Claire.mcdonald@ncl.ac.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: McDonald
authors.affiliation: Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Winge
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Burn
mesh_terms: D019468:Disease Management; D015259:Dopamine Agents / Q000627:therapeutic use; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D010300:Parkinson Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
chemical_list: D015259:Dopamine Agents
keywords: Incontinence; Lower urinary tract; Over active bladder; Parkinson's disease