International Urology and Nephrology

, Volume 44, Issue 2, pp 415–424

Urinary tract dysfunction in Parkinson’s disease: a review

  • Lehana Yeo
  • Rajindra Singh
  • Mohan Gundeti
  • Jayanta M. Barua
  • Junaid Masood
Urology – Review

Abstract

Introduction

Parkinson’s disease is an extrapyramidal neurological disorder. Although motor symptoms are a predominant feature of the condition, non-motor symptoms have also been recognized. Urinary symptoms are frequently present in patients affected with Parkinson’s disease (PD). Symptoms such as urgency, frequency, nocturia and urge incontinence significantly impact the patient’s quality of life. We discuss the urinary dysfunction seen in patients with Parkinson’s disease and consider the pathophysiology, important differentials, the investigations and management options for such patients.

Materials and methods

An extensive search was performed using the PubMed®/EMBASE® databases to identify the available literature on urinary disturbances and Parkinson’s disease. Reference was also made to current national guidelines on Parkinson’s disease.

Results

Urinary disturbances are frequently observed in sufferers of Parkinson’s disease resulting in significant impact to the individual’s quality of life. Studies report that storage symptoms are present in 57–83% of patients, whereas voiding symptoms are seen in 17–27% patients. Out of all the urinary symptoms, nocturia is the most common complaint in >60% patients with PD. Urgency occurs in 33–54% of patients, whilst frequency is experienced by 16–36% of patients. Detrusor overactivity (DO) is the commonest cystometric abnormality in patients with PD. The rate of neurogenic DO in patients with PD is 45–93%.

The main differential to consider is Multiple System Atrophy (MSA) in which all patients are ultimately afflicted with urinary disturbance. It is well recognized that patients initially diagnosed with PD may in fact have MSA, and it is important to distinguish the two as their urological management is different. Patients presenting with refractory LUTS with concurrent PD should undergo full urodynamic investigation including cystometry, flowmetry and ultrasonography before treatment is initiated.

Discussion

Referral to a urologist is advised in those with persistent or refractory urinary complaints. Urodynamic evaluation allows determination of the underlying bladder disorder; however, post-void residuals suffice in the uncomplicated patient. The pathophysiology of urinary dysfunction and current investigation and treatment modalities are discussed.

Keywords

Urinary dysfunction Parkinson disease Review 

References

  1. 1.
    Sakakibara R, Shinotoh H, Uchiyama T et al (2001) Questionnaire-based assessment of pelvic organ dysfunction in Parkinson’s disease. Auton Neurosci 92(1–2):76–85PubMedCrossRefGoogle Scholar
  2. 2.
    National Collaborating Centre for Chronic Conditions (2006) Parkinson’s disease: national clinical guideline for diagnosis and management in primary and secondary care. Royal College of Physicians, LondonGoogle Scholar
  3. 3.
    Winge K, Fowler CJ (2006) Bladder dysfunction in parkinsonism: mechanisms, prevalence, symptoms, and management. Mov Disord 21(6):737–745PubMedCrossRefGoogle Scholar
  4. 4.
    Blackett H, Walker R, Wood B (2009) Urinary dysfunction in Parkinson’s disease: a review. Parkinsonism Relat Disord 15:81–87PubMedCrossRefGoogle Scholar
  5. 5.
    Sakakibara R, Uchiyama T, Yamanishi T et al (2010) Review: genitourinary dysfunction in Parkinson’s disease. Mov Disord 25(1):2–12PubMedCrossRefGoogle Scholar
  6. 6.
    Barone P, Antonini A, Colosimo C et al (2009) The Priamo study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov Disord 24(11):1641–1649PubMedCrossRefGoogle Scholar
  7. 7.
    Braak H, Ghebremedhin E, Rub U et al (2004) Stages in the development of Parkinson’s disease-related pathology. Cell Tissue Res 318:121–134PubMedCrossRefGoogle Scholar
  8. 8.
    Andersen JT (1958) Disturbances of bladder and urethral function in Parkinson’s disease. Int Urol Nephrol 17:35–41CrossRefGoogle Scholar
  9. 9.
    Murhaghan GF (1961) Neurogenic disorders of the bladder in Parkinsonism. Br J Urol 33:403–409CrossRefGoogle Scholar
  10. 10.
    Hattori T, Yasuda K, Kita K et al (1992) Voiding dysfunction in Parkinson’s disease. Jpn J Psychiatry Neurol 46(1):181–186PubMedGoogle Scholar
  11. 11.
    Araki I, Kuno S (2000) Assessment of voiding dysfunction in Parkinson’s disease by the international prostate symptom score. J Neurol Neurosurg Psychiatry 68(4):429–433PubMedCrossRefGoogle Scholar
  12. 12.
    Lemack GE, Dewey RB, Roehrborn CG et al (2000) Questionnaire-based assessment of bladder dysfunction in patients with mild to moderate Parkinson’s disease. Urology 56:250–254PubMedCrossRefGoogle Scholar
  13. 13.
    Campos-Sousa RN, Quagliato E, da Silva BB et al (2003) Urinary symptoms in Parkinson’s disease: prevalence and associated factors. Arq Neuropsiquiatr 61(2B):359–363PubMedCrossRefGoogle Scholar
  14. 14.
    Blok BF, Holstege G (1994) Direct projections from the peri-aqueductal grey matter to the pontine micturition centre M-region. An antegrade and retrograde tracing study in the cat. Neurosci Lett 166:93–96PubMedCrossRefGoogle Scholar
  15. 15.
    Hashimoto K, Oyama T, Sugiyama T et al (2003) Neuronal excitation in the ventral tegmental area modulates the micturition reflex mediated via the dopamine D(1) and D(2) receptors in rats. J Pharmacol Sci 92:143–148PubMedCrossRefGoogle Scholar
  16. 16.
    Ruch TC (1974) The urinary bladder. In: Ruch TC, Patton HD (eds) Physiology and biophysics: circulation, respiration and fluid balance, vol 2. W. B. Saunders Co, Philadelphia, pp 525–546Google Scholar
  17. 17.
    Stocchi F, Carbone A, Inghilleri M (1997) Urodynamic and neurophysiological evaluation of Parkinson’s disease and multiple system atrophy. J Neurol Neurosurg Psychiatry 62(5):507–511PubMedCrossRefGoogle Scholar
  18. 18.
    Kitta T, Kakizaki H, Furuno T et al (2006) Brain activation during detrusor overactivity in patients with Parkinson’s disease: a positron emission tomography study. J Urol 175(3 Pt 1):994–998PubMedCrossRefGoogle Scholar
  19. 19.
    Finazzi-Agro E, Peppe A, d’Amico A et al (2003) Effects of subthalamic nucleus stimulation on urodynamic findings in patients with Parkinson’s disease. J Urol 169:1388–1391PubMedCrossRefGoogle Scholar
  20. 20.
    Andersen JT, Bradley WE (1976) Cystometric, sphincter and electromyelographic abnormalities in Parkinson’s disease. J Urol 116:75–78PubMedGoogle Scholar
  21. 21.
    Dick JPR, Cowan JMA, Day BL (1984) The corticomotoneurone connection is normal in Parkinson’s disease. Nature 310:407–409PubMedCrossRefGoogle Scholar
  22. 22.
    Winge K, Nielsen KK, Stimpel H et al (2007) Lower urinary tract symptoms and bladder control in advanced Parkinson’s disease: effects of deep brain stimulation in the subthalamic nucleus. Mov Disord 22(2):220–225PubMedCrossRefGoogle Scholar
  23. 23.
    Winge K, Friberg L, Werdelin L et al (2005) Relationship between nigrostriatal dopaminergic degeneration, urinary symptoms, and bladder control in Parkinson’s disease. Eur J Neurol 12:842–850PubMedCrossRefGoogle Scholar
  24. 24.
    Bonnet AM et al (1997) Urinary disturbances in striatonigral degeneration and Parkinson’s disease: clinical and urodynamic aspects. Mov Disord 12(4):509–513PubMedCrossRefGoogle Scholar
  25. 25.
    Winge K, Skau A, Stimpel H et al (2006) Prevalence of bladder dysfunction in Parkinson’s disease. Neurourol Urodyn 25:116–122PubMedCrossRefGoogle Scholar
  26. 26.
    Chandiramani VA, Palace J, Fowler CJ (1997) How to recognize patients with parkinsonism who should not have urological surgery. Br J Urol 80:100–104PubMedCrossRefGoogle Scholar
  27. 27.
    Defrietas GA, Lemack GE, Zimmern PE et al (2003) Distinguishing neurogenic from non-neurogenic detrusor overactivity: a urodynamic assessment of lower urinary tract symptoms in patients with and without Parkinson’s Disease. Urology 63:651–655CrossRefGoogle Scholar
  28. 28.
    Gray R, Stern G, Malone-Lee J (1995) Lower urinary tract dysfunction in Parkinson’s disease: changes related to age and not disease. Age Ageing 24(6):499–504PubMedCrossRefGoogle Scholar
  29. 29.
    Singer C (2007) Urological dysfunction. Vol II in Parkinson’s disease and nonmotor dysfunction. Humana Press, Totowa, pp 139–148Google Scholar
  30. 30.
    Abrams P, Cardozo L, Fall M et al (2002) Standardisation sub-committee of the international continence society. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourol Urodyn 21(2):167–178PubMedCrossRefGoogle Scholar
  31. 31.
    Pavlakis AJ, Siroky MB, Goldstein I et al (1983) Neurologic findings in Parkinson’s disease. J Urol 129:80–83PubMedGoogle Scholar
  32. 32.
    Fitzmaurice H, Fowler CJ, Rickards D et al (1985) Micturition disturbance in Parkinson’s disease. Br J Urol 57:652–656PubMedCrossRefGoogle Scholar
  33. 33.
    Araki I, Kitahara M, Oida T et al (2000) Voiding dysfunction and Parkinson’s disease: urodynamic abnormalities and urinary symptoms. J Urol 164:1640–1643PubMedCrossRefGoogle Scholar
  34. 34.
    Berger Y, Blaivas JG, de la Rocha ER et al (1987) Urodynamic findings in Parkinson’s disease. J Urol 138(4):836–838PubMedGoogle Scholar
  35. 35.
    Sakakibara R, Hattori T, Uchiyama T et al (2001) Videourodynamic and sphincter motor unit potential analyses in Parkinson’s disease and multiple system atrophy. J Neurol Neurosurg Psychiatry 71:600–606PubMedCrossRefGoogle Scholar
  36. 36.
    Winge K, Stimpel H, Nielsen KK et al (2005) Prevalence of bladder dysfunction in Parkinson’s disease. Mov Disord 20(Suppl 10):102Google Scholar
  37. 37.
    Aranda B, Cramer P (1993) Effect of apomorphine and L-dopa on the parkinsonian bladder. Neurourol Urodyn 12(3):203–209PubMedCrossRefGoogle Scholar
  38. 38.
    Winge K, Werdelin LM, Nielsen KK et al (2004) Effects of dopaminergic treatment on bladder function in Parkinson’s disease. Neurourol Urodyn 23:689–696PubMedCrossRefGoogle Scholar
  39. 39.
    Christmas TJ, Chapple CR, Lees AJ et al (1988) Role of apomorphine in parkinsonian voiding dysfunction. Lancet 8626–8627:1451–1453CrossRefGoogle Scholar
  40. 40.
    Brusa L, Petta F, Pisani A et al (2006) Central acute D2 stimulation worsens bladder function in patients with mild Parkinson’s disease. J Urol 175(1):202–207PubMedCrossRefGoogle Scholar
  41. 41.
    Brusa L, Petta F, Pisani A et al (2007) Acute vs chronic effects of L-dopa on bladder function in patients with mild Parkinson’s disease. Neurology 68:1455–1459PubMedCrossRefGoogle Scholar
  42. 42.
    Uchiyama T, Sakakibara R, Hattori T et al (2003) Short-term effect of a single levopdopa dose on micturition disturbance in Parkinson’s disease with the wearing off phenomenon. Mov Disord 18(5):573–578PubMedCrossRefGoogle Scholar
  43. 43.
    Porter RW, Bors E (1971) Neurogenic bladder in parkinsonism: effect of thalamotomy. J Neurosurg 34:27–32PubMedCrossRefGoogle Scholar
  44. 44.
    Khan Z, Starer P, Bhola A (1989) Urinary incontinence in female Parkinson disease patients: pitfalls of diagnosis. Urology 33:486–489PubMedCrossRefGoogle Scholar
  45. 45.
    Quinn N (1995) Parkinsonism–Recognition and differential diagnosis. Br Med J 310:447–452CrossRefGoogle Scholar
  46. 46.
    Kirchhof K, Apostolidis AN, Mathias CJ et al (2003) Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a retrospective study. Int J Impot Res 15:293–298PubMedCrossRefGoogle Scholar
  47. 47.
    Sakakibara R, Hattori T, Uchiyama T (2000) Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation? J Neurol Neurosurg Psychiatry 68:65–69PubMedCrossRefGoogle Scholar
  48. 48.
    Berger Y, Salinas JM, Blaivas JG (1990) Urodynamic differentiation of Parkinson disease and the Shy-Drager syndrome. Neurourol Urodyn 9:117–121CrossRefGoogle Scholar
  49. 49.
    Sotolongo JR (1988) Voiding dysfunction in Parkinson’s disease. Semin Neurol 8(2):166–169PubMedCrossRefGoogle Scholar
  50. 50.
    Fowler CJ (2007) Update on the neurology of Parkinson’s disease. Neurourol Urodyn 26:103–109PubMedCrossRefGoogle Scholar
  51. 51.
    Krahn HP, Morales PA (1965) The effect of pudendal nerve anaesthesia on urinary continence after prostatectomy. J Urol 94:282PubMedGoogle Scholar
  52. 52.
    Andersson KE (2000) Treatment of overactive bladder: other drug mechanisms. Urology 55:51–57PubMedCrossRefGoogle Scholar
  53. 53.
    Hineno T, Mizobuchi M, Hiratani K et al (1992) Disappearance of circadian rhythms in Parkinson’s disease model induced by 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine in dogs. Brain Res 580:92–99PubMedCrossRefGoogle Scholar
  54. 54.
    Wallace PA, Lane FL, Noblett KL (2007) Sacral nerve neuromodulation in patients with underlying neurologic disease. Am J Obstet Gynecol 197:96.e1–96.e5CrossRefGoogle Scholar
  55. 55.
    Kabay SC, Yucel M, Ozden H (2009) Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson’s disease. Neurourol Urodyn 28:62–67PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Lehana Yeo
    • 1
  • Rajindra Singh
    • 1
  • Mohan Gundeti
    • 2
  • Jayanta M. Barua
    • 2
  • Junaid Masood
    • 1
    • 3
  1. 1.Department of UrologyBarts and The London NHS TrustLondonUK
  2. 2.King George HospitalIlford, EssexUK
  3. 3.Ashtead, SurreyUK

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