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Current Urology Reports

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01.09.2014 | Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)

A Review of Lower Urinary Tract Symptoms in Patients with Parkinson’s Disease

verfasst von: Anand V. Badri, Rajveer S. Purohit, Jason Skenazy, Jeffrey P. Weiss, Jerry G. Blaivas

Erschienen in: Current Urology Reports | Ausgabe 9/2014

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Abstract

To critically review recent literature on lower urinary tract symptoms (LUTS) in patients with Parkinson’s Disease.A literature search was conducted using the keywords LUTS, urinary symptoms, non-motor, and Parkinson’s disease (PD) via the PubMed/Medline search engine. In the literature, we critically examined lower urinary symptoms in Parkinson’s patients by analyzing prevalence, pathogenesis, urinary manifestations, pharmacologic trials and interventions, and prior review articles. The data collected ranged from 1986 to the present with an emphasis placed on recent publications.The literature regards LUTS in PD as a major comorbidity, especially with respect to a patient’s quality of life. Parkinson’s patients experience both storage and voiding difficulties. Storage symptoms, specifically overactive bladder, are markedly worse in patients with PD than in the general population. Surgical management of prostatic obstruction in PD can improve urinary symptoms. Multiple management options exist to alleviate storage LUTS in patients with PD, ranging from behavioral modification to surgery, and vary in efficacy.Lower urinary tract dysfunction in PD may be debilitating. Quality of life can be improved with a multi-pronged diagnosis-specific approach to treatment that takes into consideration a patient’s ability to comply with treatment. A stepwise algorithm is presented and may be utilized by clinicians in managing LUTS in Parkinson’s patients.

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Perez-Lloret S, Rey MV, Pavy-Le Traon A, Rascol O. Emerging drugs for autonomic dysfunction in Parkinson’s disease. Expert Opin Emerg Drugs. 2013;18(1):39–53. -Pharmacotherapeutical article assessing multiple drugs for PD-associated autonomic dysfunction. -Specifically for this review, compared muscarinic antagonists for women with urge incontinence. In order of decreasing efficacy (#women with restored continence/1000): fesoterodine → oxybutynin (Only one that’s FDA approved although less efficacious) → trospium → solifenacin → tolterodine. -Botulinum Toxin A – positive effect for incontinence, detrusor overactivity, painful bladder syndrome, BPH. -Suggests need for further study based on IPSS and DanPSS for subjectivity and weighing protective pads for incontinence testing pre/post treatment for objectivity. PubMedCrossRef

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Ashkan K, Samuel M, Reddy P, Ray CK. The impact of deep brain stimulation on the nonmotor symptoms of Parkinson’s disease. J Neural Transm. 2013;120(4):639–42. -This paper suggests that “DBS has a major potential to contribute towards the holistic care of PD patients.” This is in light of an increase in the ability to more objectively assess the effect of DBS on the nonmotor burden in PD pts. -Nonmotor Symptoms Screening Questionnaire (NMSQuest) is a 30-item validated questionnaire to assess nonmotor burden in 545 pts with PD pre/post DBS. -Suggest that DBS shows no worsening of symptomatology. -Adverse effects include: transient psychiatric and mood disturbance (depression, hypomania, delirium), apathy, impaired verbal fluency, and impulse control disorders. Mechanism unclear, but may involve lesioning effect of frontostriatal circuits along the trajectory of the electrode, suboptimal positioning of the electrodes, current spread to adjacent structures, or non-judicial post-surgical medication adjustment. PubMedCrossRef

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Winge K, Nielsen KK. Bladder dysfunction in advanced Parkinson’s disease. Neurourol Urodyn. 2012;31(8):1279–83. – Aim: To assess severity of bladder dysfunction in PD as stratified by symptomatic treatment, specifically DBS and Apomorphine vs medical treatment. – Used two validated questionnaires: DanPSS and IPSS. Used these to assess symptomatology and impact on quality of life. – The analysis found that in the conventional group, the severity of bladder dysfunction (DanPSS ≥ 10) correlated with a greater PD stage (based on the modified Hoehn and Yahr PD staging from 0 to 5). This did not hold for the nonconventional group, however, which included those treated with DBS or apomorphine and also did not hold when given the IPSS validated questionnaire. – They completed a further analysis based on specific symptoms and found that DBS patients had significantly less nocturia (as defined by > 2 episodes of voiding per night) and were less bothered by it. – Drawbacks: ○ Definition of nocturia in the DanPSS isn’t rigorous as the established ICS definition of nocturia (minimum one episode of waking to void that is preceded and followed by sleep) ○ Low N in general (N=107), but specifically in Apomorphine group (n=9). Unable to draw substantial conclusions from such a low sample size. ○ Only looked into questionnaire-based evaluation. Lacks the objectivity of other studies, as it doesn’t include urodynamic testing, etc.PubMedCrossRef

Titel: A Review of Lower Urinary Tract Symptoms in Patients with Parkinson’s Disease
verfasst von: Anand V. Badri
Rajveer S. Purohit
Jason Skenazy
Jeffrey P. Weiss
Jerry G. Blaivas
Publikationsdatum: 01.09.2014
Verlag: Springer US
Erschienen in: Current Urology Reports / Ausgabe 9/2014
Print ISSN: 1527-2737
Elektronische ISSN: 1534-6285
DOI: https://doi.org/10.1007/s11934-014-0435-0

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