Skip to main content
SpringerLink
Log in

Urological Dysfunction

  • Chapter
  • First Online:
Parkinson’s Disease and Nonmotor Dysfunction

Part of the book series: Current Clinical Neurology ((CCNEU))

  • 2572 Accesses

Abstract

Symptoms of urinary dysfunction occur frequently in patients with Parkinson’s disease (PD), particularly men. Irritative symptoms, such as frequency, urgency, and urge incontinence, are reported in 57–83% of patients with PD. Obstructive symptoms, such as hesitancy and weak urinary stream, may be present in 17–36% of individuals. The appearance of urinary symptoms may follow the appearance of motor symptoms by a few years. Several mechanisms, such as detrusor hyperreflexia, detrusor areflexia, coexistent obstructive uropathies, and dysfunction of infravesical mechanisms, can be responsible for the urinary dysfunction in patients with PD. Detrusor hyperreflexia is the urodynamic correlate of irritative urinary symptoms. Detrusor areflexia is uncommon in PD and, when present, is usually secondary to the use of anticholinergic medications. Coexistent obstructive uropathies may complicate the clinical picture in patients with PD and produce both obstructive and irritative symptoms. Urinary dysfunction in PD also may be the result of dysfunctional infravesical mechanisms such as sphincter bradykinesia. In terms of pathogenesis, voiding dysfunction in PD is primarily due to the loss of the inhibitory effect that the basal ganglia exert on the pontine micturition center. This inhibitory effect likely is mediated by D1 dopamine receptors and results in a “quiet bladder” during the filling phase. In terms of treatment, the irritative symptoms often can be treated successfully with anticholinergic drugs; however, for refractory overactive bladder, intravesical botulinum toxin injections or deep brain stimulation surgery may be required. If the symptoms are obstructive in nature, bladder catheterization and sometimes urological surgery may be necessary.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Araki I, Kuno S. Assessment of voiding dysfunction in Parkinson’s disease by the international prostate symptom score. J Neurol Neurosurg Psychiatry. 2000;68(4):429–33.

    Article  PubMed  CAS  Google Scholar 

  2. Campos-Sousa RN, Quagliato E, da Silva BB, de Carvalho Jr RM, Ribeiro SC, de Carvalho DF. Urinary symptoms in Parkinson’s disease: prevalence and associated factors. Arq Neuropsiquiatr. 2003;61(2B):359–63.

    Article  PubMed  Google Scholar 

  3. Hobson P, Islam W, Roberts S, Adhiyman V, Meara J. The risk of bladder and autonomic dysfunction in a community cohort of Parkinson’s disease patients and normal controls. Parkinsonism Relat Disord. 2003;10(2):67–71.

    Article  PubMed  Google Scholar 

  4. Singer C, Weiner WJ, Sanchez-Ramos JR. Autonomic dysfunction in men with Parkinson’s disease. Eur Neurol. 1992;32(3):134–40.

    Article  PubMed  CAS  Google Scholar 

  5. Sakakibara R, Shinotoh H, Uchiyama T, et al. Questionnaire-based assessment of pelvic organ dysfunction in Parkinson’s disease. Auton Neurosci. 2001;92(1–2):76–85.

    Article  PubMed  CAS  Google Scholar 

  6. Sammour ZM, Gomes CM, Barbosa ER, et al. Voiding dysfunction in patients with Parkinson’s disease: impact of neurological impairment and clinical parameters. Neurourol Urodyn. 2009;28(6):510–5.

    Article  PubMed  Google Scholar 

  7. Murnaghan GF. Neurogenic disorders of the bladder in Parkinsonism. Br J Urol. 1961;33:403–9.

    Article  PubMed  CAS  Google Scholar 

  8. Raz S. Parkinsonism and neurogenic bladder. Experimental and clinical observations. Urol Res. 1976;4(3):133–8.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  10. Pavlakis AJ, Siroky MB, Goldstein I, Krane RJ. Neurourologic findings in Parkinson’s disease. J Urol. 1983;129(1):80–3.

    PubMed  CAS  Google Scholar 

  11. Porter RW, Bors E. Neurogenic bladder in parkinsonism: effect of thalamotomy. J Neurosurg. 1971;34(1):27–32.

    Article  PubMed  CAS  Google Scholar 

  12. Niimi Y, Ieda T, Hirayama M, et al. Clinical and physiological characteristics of autonomic failure with Parkinson’s disease. Clin Auton Res. 1999;9(3):139–44.

    Article  PubMed  CAS  Google Scholar 

  13. Chandiramani VA, Palace J, Fowler CJ. How to recognize patients with parkinsonism who should not have urological surgery. Br J Urol. 1997;80(1):100–4.

    Article  PubMed  CAS  Google Scholar 

  14. Raudino F. Non motor off in Parkinson’s disease. Acta Neurol Scand. 2001;104(5):312–5.

    Article  PubMed  CAS  Google Scholar 

  15. Araki I, Kitahara M, Oida T, Kuno S. Voiding dysfunction and Parkinson’s disease: urodynamic abnormalities and urinary symptoms. J Urol. 2000;164(5):1640–3.

    Article  PubMed  CAS  Google Scholar 

  16. Sakakibara R, Shinotoh H, Uchiyama T, Yoshiyama M, Hattori T, Yamanishi T. SPECT imaging of the dopamine transporter with [(123)I]-beta-CIT reveals marked decline of nigrostriatal dopaminergic function in Parkinson’s disease with urinary dysfunction. J Neurol Sci. 2001;187(1–2):55–9.

    Article  PubMed  CAS  Google Scholar 

  17. Andersen JT. Disturbances of bladder and urethral function in Parkinson’s disease. Int Urol Nephrol. 1985;17(1):35–41.

    Article  PubMed  CAS  Google Scholar 

  18. Martignoni E, Pacchetti C, Godi L, Micieli G, Nappi G. Autonomic disorders in Parkinson’s disease. J Neural Transm Suppl. 1995;45:11–9.

    PubMed  CAS  Google Scholar 

  19. Galloway NT. Urethral sphincter abnormalities in Parkinsonism. Br J Urol. 1983;55(6):691–3.

    Article  PubMed  CAS  Google Scholar 

  20. Fitzmaurice H, Fowler CJ, Rickards D, et al. Micturition disturbance in Parkinson’s disease. Br J Urol. 1985;57(6):652–6.

    Article  PubMed  CAS  Google Scholar 

  21. Stocchi F, Carbone A, Inghilleri M, et al. Urodynamic and neurophysiological evaluation in Parkinson’s disease and multiple system atrophy. J Neurol Neurosurg Psychiatry. 1997;62(5):507–11.

    Article  PubMed  CAS  Google Scholar 

  22. Andersen JT, Bradley WE. Cystometric, sphincter and electromyelographic abnormalities in Parkinson’s disease. J Urol. 1976;116(1):75–8.

    PubMed  CAS  Google Scholar 

  23. Sotolongo Jr JR. Voiding dysfunction in Parkinson’s disease. Semin Neurol. 1988;8(2):166–9.

    Article  PubMed  Google Scholar 

  24. Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. JAMA. 1987;257(22):3076–81.

    Article  PubMed  CAS  Google Scholar 

  25. Andersen JT, Hebjorn S, Frimodt-Moller C, Walter S, Worm-Petersen J. Disturbances of micturition in Parkinson’s disease. Acta Neurol Scand. 1976;53(3):161–70.

    Article  PubMed  CAS  Google Scholar 

  26. Berger Y, Salinas JN, Blaivas JG. Urodynamic differentiation of Parkinson’s disease and Shy Dragger syndrome. Neurourol Urodyn. 1990;9:117–21.

    Article  Google Scholar 

  27. Christmas TJ, Kempster PA, Chapple CR, et al. Role of subcutaneous apomorphine in parkinsonian ­voiding dysfunction. Lancet. 1988;2(8626–8627):1451–3.

    Article  PubMed  CAS  Google Scholar 

  28. Uchiyama T, Sakakibara R, Hattori T, Yamanishi T. Short-term effect of a single levodopa dose on micturition disturbance in Parkinson’s disease patients with the wearing-off phenomenon. Mov Disord. 2003;18(5):573–8.

    Article  PubMed  Google Scholar 

  29. Fowler CJ. Urinary disorders in Parkinson’s disease and multiple system atrophy. Funct Neurol. 2001;16(3):277–82.

    PubMed  CAS  Google Scholar 

  30. Singer C, Weiner WJ, Sanchez-Ramos J, Ackerman M. Sexual function in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1991;54(10):942.

    Article  PubMed  CAS  Google Scholar 

  31. Eardley I, Quinn NP, Fowler CJ, et al. The value of urethral sphincter electromyography in the differential diagnosis of parkinsonism. Br J Urol. 1989;64(4):360–2.

    Article  PubMed  CAS  Google Scholar 

  32. Vodusek DB. Sphincter EMG and differential diagnosis of multiple system atrophy. Mov Disord. 2001;16(4):600–7.

    Article  PubMed  CAS  Google Scholar 

  33. Chancellor MB, Yoshimura N. Neurophysiology of stress urinary incontinence. Rev Urol. 2004;6 Suppl 3:S19–28.

    PubMed  Google Scholar 

  34. Keane DP, O’Sullivan S. Urinary incontinence: anatomy, physiology and pathophysiology. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14(2):207–26.

    Article  PubMed  CAS  Google Scholar 

  35. Blok BF, Willemsen AT, Holstege G. A PET study on brain control of micturition in humans. Brain. 1997;120(Pt 1):111–21.

    Article  PubMed  Google Scholar 

  36. Nour S, Svarer C, Kristensen JK, Paulson OB, Law I. Cerebral activation during micturition in normal men. Brain. 2000;123(Pt 4):781–9.

    Article  PubMed  Google Scholar 

  37. Griffiths DJ. The pontine micturition centres. Scand J Urol Nephrol Suppl. 2002;(210):21–6.

    Google Scholar 

  38. Matsuura S, Kakizaki H, Mitsui T, Shiga T, Tamaki N, Koyanagi T. Human brain region response to distention or cold stimulation of the bladder: a positron emission tomography study. J Urol. 2002;168(5):2035–9.

    Article  PubMed  Google Scholar 

  39. Kavia RB, Dasgupta R, Fowler CJ. Functional imaging and the central control of the bladder. J Comp Neurol. 2005;493(1):27–32.

    Article  PubMed  Google Scholar 

  40. 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 

  41. Lewin RJ, Dillard GV, Porter RW. Extrapyramidal inhibition of the urinary bladder. Brain Res. 1967;4(4):301–7.

    Article  PubMed  CAS  Google Scholar 

  42. Lewin RJ, Porter RW. Inhibition of spontaneous bladder activity by stimulation of the globus pallidus. Neurology. 1965;15(11):1049–52.

    Article  PubMed  CAS  Google Scholar 

  43. Athwal BS, Berkley KJ, Hussain I, et al. Brain responses to changes in bladder volume and urge to void in healthy men. Brain. 2001;124(Pt 2):369–77.

    Article  PubMed  CAS  Google Scholar 

  44. Kitta T, Kakizaki H, Furuno T, et al. Brain activation during detrusor overactivity in patients with Parkinson’s disease: a positron emission tomography study. J Urol. 2006;175(3 Pt 1):994–8.

    Article  PubMed  Google Scholar 

  45. Abramovicz M. Tolterodine for overactive bladder. Med Lett. 1998;40:101–3.

    Google Scholar 

  46. Siroky MB. Neurological disorders cerebrovascular disease and parkinsonism. Urol Clin North Am. 2003;30(1):27–47, v.

    Google Scholar 

  47. Abramovicz M. Oxybutynin transdermal (Oxytrol) for overactive bladder. Med Lett. 2003;45(1156):38–9.

    Google Scholar 

  48. Appell RA. Pharmacotherapy for overactive bladder: an evidence-based approach to selecting an antimuscarinic agent. Drugs. 2006;66(10):1361–70.

    Article  PubMed  CAS  Google Scholar 

  49. Biastre K, Burnakis T. Trospium chloride treatment of overactive bladder. Ann Pharmacother. 2009;43(2):283–95.

    PubMed  CAS  Google Scholar 

  50. Staskin DR, Rosenberg MT, Sand PK, Zinner NR, Dmochowski RR. Trospium chloride once-daily extended release is effective and well tolerated for the treatment of overactive bladder syndrome: an integrated analysis of two randomised, phase III trials. Int J Clin Pract. 2009;63(12):1715–23.

    Article  PubMed  CAS  Google Scholar 

  51. Giannantoni A, Mearini E, Del Zingaro M, Santaniello F, Porena M. Botulinum A toxin in the treatment of neurogenic detrusor overactivity: a consolidated field of application. BJU Int. 2008;102 Suppl 1:2–6.

    Article  PubMed  CAS  Google Scholar 

  52. Giannantoni A, Rossi A, Mearini E, Del Zingaro M, Porena M, Berardelli A. Botulinum toxin A for overactive bladder and detrusor muscle overactivity in patients with Parkinson’s disease and multiple system atrophy. J Urol. 2009;182(4):1453–7.

    Article  PubMed  Google Scholar 

  53. Finazzi-Agro E, Peppe A, D’Amico A, et al. Effects of subthalamic nucleus stimulation on urodynamic findings in patients with Parkinson’s disease. J Urol. 2003;169(4):1388–91.

    Article  PubMed  Google Scholar 

  54. Seif C, Herzog J, van der Horst C, et al. Effect of subthalamic deep brain stimulation on the function of the urinary bladder. Ann Neurol. 2004;55(1):118–20.

    Article  PubMed  Google Scholar 

  55. Shimizu N, Matsumoto S, Mori Y, et al. Effects of deep brain stimulation on urodynamic findings in patients with Parkinson’s disease. Hinyokika Kiyo. 2007;53(9):609–12.

    PubMed  Google Scholar 

  56. Winge K, Nielsen KK, Stimpel H, Lokkegaard A, Jensen SR, Werdelin L. Lower urinary tract symptoms and bladder control in advanced Parkinson’s disease: effects of deep brain stimulation in the subthalamic nucleus. Mov Disord. 2007;22(2):220–5.

    Article  PubMed  Google Scholar 

  57. Herzog J, Weiss PH, Assmus A, et al. Subthalamic stimulation modulates cortical control of urinary bladder in Parkinson’s disease. Brain. 2006;129(Pt 12):3366–75.

    Article  PubMed  Google Scholar 

  58. Edwards MJ, Talelli P, Rothwell JC. Clinical applications of transcranial magnetic stimulation in patients with movement disorders. Lancet Neurol. 2008;7(9):827–40.

    Article  PubMed  Google Scholar 

  59. Brusa L, Agro EF, Petta F, et al. Effects of inhibitory rTMS on bladder function in Parkinson’s disease patients. Mov Disord. 2009;24(3):445–8.

    Article  PubMed  Google Scholar 

  60. Kabay SC, Kabay S, Yucel M, Ozden H. Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson’s disease. Neurourol Urodyn. 2009;28(1):62–7.

    Article  PubMed  Google Scholar 

  61. Vodusek DB, Light JK, Libby JM. Detrusor inhibition induced by stimulation of pudendal nerve afferents. Neurourol Urodyn. 1986;5:381–9.

    Article  Google Scholar 

  62. Fall M, Lindstrom S. Electrical stimulation. A physiologic approach to the treatment of urinary incontinence. Urol Clin North Am. 1991;18(2):393–407.

    PubMed  CAS  Google Scholar 

  63. Krivoborodov GG, Gekht AB, Korshunova ES. Tibial neuromodulation in the treatment of neurogenic detrusor hyperactivity in patients with Parkinson’s disease. Urologiia. 2006;(4):3–6.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Parkinson’s Disease and Movement Disorder Center, Department of Neurology, University of Miami – Miller School of Medicine, 1501 NW 9th Ave., 2nd Floor, Room # 2031A, Miami, FL, 33136, USA

    Henry Moore M.D. & Carlos Singer M.D.

Authors
  1. Henry Moore M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos Singer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos Singer M.D. .

Editor information

Editors and Affiliations

  1. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA

    Ronald F. Pfeiffer (Professor and Vice Chair) (Professor and Vice Chair)

  2. Parkinson’s Disease and Related Disorders Clinic, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Ivan Bodis-Wollner

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Moore, H., Singer, C. (2013). Urological Dysfunction. In: Pfeiffer, R.F., Bodis-Wollner, I. (eds) Parkinson’s Disease and Nonmotor Dysfunction. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-429-6_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-429-6_12

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-428-9

  • Online ISBN: 978-1-60761-429-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation