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

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)
  • Published:
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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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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hornykiewicz O. The discovery of dopamine deficiency in the parkinsonian brain. J Neural Transm Suppl 2006; 9.

  2. Kapoor S, Bourdoumis A, Mambu L, Barua J. Effective management of lower urinary tract dysfunction in idiopathic Parkinson’s Disease. Int J Urol. 2013;20(1):79–84. This article represents an effective and useful literature review of the urologic sequelae of PD. Taking data from 2012 and earlier, the group presents a cohesive, systematic approach to managing LUTS in PD.

    PubMed  Google Scholar 

  3. Fowler CJ, Dalton C, Panicker JN. Review of neurologic diseases for the urologist. Urol Clin N Am. 2010;37:517–26.

    Article  Google Scholar 

  4. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4.

    PubMed  Google Scholar 

  5. Blaivas JG, Panagopolous G, Weiss JP, Somaroo C, Chaikin DC. The Urgency Perception Score: Validation and Test-Retest. J Urol. 2007;177:199–202.

    Article  PubMed  Google Scholar 

  6. Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;6:453–66.

    Article  Google Scholar 

  7. Blackett H, Walker R, Wood B. Urinary dysfunction in Parkinson’s disease: A review. Parkinsonism Relat disord. 2009;15(2):81–7.

    Article  PubMed  Google Scholar 

  8. Araki I, Kuno S. Assessment of voiding dysfunction in Parkinson’s disease by the international prostate symptom score. J Neurol Neurosurg Psychiatry. 2000;68:429–33.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Lemack GE, Dewey RB, Roehrborn CG, et al. Questionnaire-based assessment of bladder dysfunction in patients with mild to moderate Parkinson’s disease. Urology. 2000;56:250–4.

    Article  CAS  PubMed  Google Scholar 

  10. Sakakibara R, Uchiyama T, Yamanishi T, et al. Bladder and bowel dysfunction in Parkinson’s Disease. J Neural Transm. 2008;115:443–60.

    Article  CAS  PubMed  Google Scholar 

  11. Ransmayr GN, Holliger S, Schletterer K, et al. Lower urinary tract symptoms in dementia with Lewy bodies, Parkinson disease, and Alzheimer disease. Neurology. 2008;70:299–303.

    Article  CAS  PubMed  Google Scholar 

  12. Berger Y, Blaivas JG, DeLaRocha ER, Salinas EM. Urodynamic findings in Parkinson’s Disease. J Urol. 1987;138(4):836–8.

    CAS  PubMed  Google Scholar 

  13. Ragab MM, Mohammed ES. Idiopathic Parkinson’s disease patients at the Urologic Clinic. Neurourol Urodyn. 2011;20:1258–61.

    Google Scholar 

  14. Siegl E, Lassen B, Saxer S. “Incontinence—a common issue for people with Parkinson’s disease. A systematic literature review”. [Article in German]. Pflege Z. 2013;66(9):540–4. -This review sought to look into the literature to determine the incidence of urinary and fecal incontinence as well as different measures for treatment or improvement. -Consisted of a review of three studies with a total sample size of n = 1077. Comparing urge incontinence between women with and without PD, they found an incidence of 25 % and 7 %, respectively. Similarly, they found an incidence of 28 % and 6 % in men with and without PD, respectively. -Suggest that pelvic floor muscle exercises as well as botulinum toxin A injections can reduce urinary incontinence, but the review doesn’t offer recommendations.

    PubMed  Google Scholar 

  15. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathologic study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55:181.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Wenning GK, Colosimo C, Geser F, Poewe W. Multiple system atrophy. Lancet Neurol. 2004;3:93.

    Article  PubMed  Google Scholar 

  17. Ozawa T, Paviour D, Quinn NP, et al. The spectrum of pathological involvement of the striatonigral and olivopontocerebellar systems in multiple system atrophy: clinicopathological correlations. Brain. 2004;127:2657.

    Article  PubMed  Google Scholar 

  18. Kircchof K, Apostolidis AN, Mathias CJ, Fowler CJ. Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a retrospective study. Int J Impot Res. 2003;15:293–8.

    Article  Google Scholar 

  19. Chandiramani VA, Palace J, Fowler CJ. How to recognize patients with parkinsonism who should not have urological surgery. Br J Urol. 1997;80:100–4.

    Article  CAS  PubMed  Google Scholar 

  20. Salinas JM, Berger Y, De La Rocha RE, Blaivas JG. Urological evaluation in the Shy Drager Syndrome. J Urol. 1986;135(4):741–3.

    CAS  PubMed  Google Scholar 

  21. Gancher ST. Modified Hoehn And Yahr Staging. In: Factor SA, Weiner WJ, editors. Parkinson’s Disease: Diagnosis and Clinical Management. New York: Demos Medical Publishing; 2002.

    Google Scholar 

  22. Weiss JP, Blaivas JG, Tash Anger JA, Di Blasio CJ, Panagopoulos G, Gerboc J. Development and validation of a new treatment outcome score for men with LUTS. Neurourol Urodyn. 2004;23(2):88–93.

    Article  PubMed  Google Scholar 

  23. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003), Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003;170:530.

    Article  Google Scholar 

  24. Tsui JF, Shah MB, Weinberger JM, Ghanaat M, Weiss JP, Purohit RS, et al. Pad count is a poor measure of the severity of urinary incontinence. J Urol. 2013;190(5):1787–90.

    Article  PubMed  Google Scholar 

  25. Nitti VW. Pressure Flow Urodynamic Studies: The Gold Standard for Diagnosing Bladder Outlet Obstruction. Rev Urol. 2005;7 Suppl 6:S14–21.

    PubMed Central  PubMed  Google Scholar 

  26. Dmochowski RR. Bladder outlet obstruction: etiology and evaluation. Rev Urol. 2005;7 Suppl 6:S3.

    PubMed Central  PubMed  Google Scholar 

  27. Flisser AJ, Walmsley K, Blaivas JG. Urodynamic classification of patients with symptoms of overactive bladder. J Urol. 2003;169(2):529–33. discussion 533-4.

    Article  PubMed  Google Scholar 

  28. Santos-Garcia D, de la Fuente-Fernandez R. Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson’s disease. J Neurol Sci. 2013;332(1–2):136–40.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  CAS  PubMed  Google Scholar 

  30. Winge K, Fowler CJ. Bladder dysfunction in Parkinsonism: Mechanisms, Prevalence, Symptoms and Management. Mov Dis. 2006;21:737–45.

    Article  Google Scholar 

  31. Winge K, Werdelin L, Nielsen K, Stimpel H. Effects of dopaminergic treatment on bladder function in Parkinson’s disease. Neurourol Urodyn. 2004;23:689–96.

    Article  CAS  PubMed  Google Scholar 

  32. Cone EB, Ellsworth P. Neurogenic detrusor overactivity: an update on management options. R I Med J. 2013;96(4):38–40. -Paper good for informing clinicians about mechanisms of treatments and the treatments available in a stepwise form from least to most invasive. -Goals should be 1) prevent upper tract damage and 2) improve symptoms/quality of life/independent living.

    Google Scholar 

  33. Giannantoni A, Conte A, Proietti S, et al. Botulinum toxin type A in patients with Parkinson’s disease and refractory overactive bladder. J Urol. 2011;186:960–4.

    Article  CAS  PubMed  Google Scholar 

  34. Anderson RU, Orenberg EK, Glowe P. Onabotulinumtoxin A office treatment for neurogenic bladder incontinence in Parkinson’s disease. Urology. 2014;83(1):22–7.

    Article  PubMed  Google Scholar 

  35. Phé V, Caremel R, Bart S, Castel-Lacanal E, de Sèze M, Duchêne F, et al. le Comité de neuro-urologie de l’Association française d’urologie. “Lower urinary tract dysfunctions in parkinsonian syndromes: a review by the Neuro-Urology Comittee of the French Association of Urology.” [Article in French]. Prog Urol. 2013;23(5):296–308. -A review of LUTS in parkinsonian syndromes completed by the French Association of Urology. -The review discussed the efficacy of Posterior Tibial Nerve Stimulation very well.

    Article  PubMed  Google Scholar 

  36. Ohannessian A, Kaboré FA, Agostini A, Lenne Aurier K, Witjas T, Azulay JP, et al. Transcutaneous tibial nerve stimulation in the overactive bladder syndrome in patients with Parkinson’s syndromes. Prog Urol. 2013;23(11):936–9.

    Article  CAS  PubMed  Google Scholar 

  37. Staskin DS, Vardi Y, Siroky MB. Post-prostatectomy continence in the parkinsonian patient: the significance of poor voluntary sphincter control. J Urol. 1988;140(1):117–8.

    CAS  PubMed  Google Scholar 

  38. Roth B, Studer UE, Fowler CJ, Kesslet TM. Benign prostatic obstruction and parkinson’s disease – should transurethral resection of the prostate be avoided? J Urol. 2009;181(5):2209–13.

    Article  PubMed  Google Scholar 

  39. Reyblat P, Ginsberg DA. Augmentation Cystoplasty: what are the indications? Curr Urol Rep. 2008;9(6):452–8.

    Article  PubMed  Google Scholar 

  40. Pannek J, Stohrer M, Blok B et al. Guidelines on neurogenic lower urinary tract dysfunction. EAU Guidelines. 2012;pp. 8–36.

  41. 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.

    Article  PubMed  Google Scholar 

  42. Wolz M, Hauschild J, Fauser M, et al. Immediate effects of deep brain stimulation of the subthalamic nucleus on nonmotor symptoms in Parkinson’s disease. Parkinsonism Relat Disord. 2012;18:994–7.

    Article  PubMed  Google Scholar 

  43. 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.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Dr. Anand V. Badri, Dr. Rajveer S. Purohit, and Dr. Jason Skenazy each declare no potential conflicts of interest.

Dr. Jeffrey P. Weiss reports personal fees from Ferring, personal fees from Pfizer, personal fees from Astellas, personal fees from Allergan, and personal fees from Vantia.

Dr. Jerry G. Blaivas reports other from Symptelligence Medical Informatics, LLC, personal fees from Astellas Pharma US, and personal fees from Mesh Lawsuits.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. State University of New York Downstate Medical Center, Brooklyn, NY, USA

    Anand V. Badri, Jason Skenazy, Jeffrey P. Weiss & Jerry G. Blaivas

  2. Institute for Bladder and Prostate Research, New York, NY, USA

    Anand V. Badri, Rajveer S. Purohit, Jeffrey P. Weiss & Jerry G. Blaivas

  3. Weill Cornell Medical College, New York, NY, USA

    Rajveer S. Purohit & Jerry G. Blaivas

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  1. Anand V. Badri
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  2. Rajveer S. Purohit
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  3. Jason Skenazy
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Correspondence to Anand V. Badri.

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This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

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Badri, A.V., Purohit, R.S., Skenazy, J. et al. A Review of Lower Urinary Tract Symptoms in Patients with Parkinson’s Disease. Curr Urol Rep 15, 435 (2014). https://doi.org/10.1007/s11934-014-0435-0

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  • DOI: https://doi.org/10.1007/s11934-014-0435-0

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