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Degenerative Diseases (Multiple Sclerosis, Parkinson’s Disease)

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Neuro-Urology

Abstract

Lower urinary tract symptoms (LUTS) and incontinence are highly prevalent among multiple sclerosis (MS ) patients and are strongly related to the duration, progress and severity of the neurological condition. Mixed LUTS are common, with a higher prevalence of detrusor overactivity (DO) in urodynamic investigations. Interestingly, upper urinary tract damage is infrequent in MS patients. Despite the negative effect on QoL, the majority of MS patients do not consult a urologist. Available treatments are similar as in non-neurogenic LUTS, albeit with a lower level of evidence apart from intradetrusor injections of botulinum neurotoxin A. Lifestyle interventions with or without antimuscarinics and clean intermittent catheterizations are the mainstay of management, but with significant rates of discontinuation. Invasive surgery (enterocystoplasty, urinary diversion procedures) is spared for refractory cases and those patients with upper extremity dexterity issues.

Similarly, LUTS are common in Parkinson’s disease (PD) patients, with nocturia being the most prevalent symptom and DO the most common urodynamic observation, followed by detrusor underactivity and bladder outlet obstruction. Antimuscarinics are the mainstay of medical treatment for storage LUTS in PD patients, while sparse data exist on the use of alpha-blockers. Surgical treatment of bladder outlet obstruction (BOO) is no longer a contraindication in PD patients so long as multiple system atrophy is excluded. Minimally invasive treatments, such as botulinum-A toxin bladder injections, percutaneous tibial nerve stimulation and deep brain stimulation, are considered in cases of refractory symptoms. Manipulation of the gut and urinary microbiota might play a role in the therapeutic management of both PD and associated LUTS in the future.

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Abbreviations

ASST:

Actionable Bladder Symptom and Screening Tool

BOO:

Bladder outlet obstruction

BPO:

Benign prostatic obstruction

CIC:

Clean Intermittent Catheterization

DO:

Detrusor overactivity

DRE:

Digital rectal examination

DSD:

Detrusor sphincter dyssynergia

DUA:

Detrusor underactivity

EAU:

European Association of Urology

EDSS:

Expanded Disability Status Scale

IPSS:

International Prostate Symptom Score

ISC:

Intermittent self-catheterization

LUTS:

Lower urinary tract symptoms

MS:

Multiple sclerosis

MSA:

Multiple system atrophy

NLUTS:

Neurogenic lower urinary tract symptoms

NMS:

Non-motor symptoms

OAB:

Overactive bladder

OR:

Odds ratio

PD:

Parkinson’s disease

POP:

Pelvic organ prolapse

PPMS:

Primary progressive multiple sclerosis

PR:

Progressive relapsing

PROMs:

Patient-reported outcome measures

PTNS:

Percutaneous tibial nerve stimulation

PVR:

Post-void residual

QoL:

Quality of life

RRMS:

Relapsing–remitting multiple sclerosis

SCI:

Spinal cord injury

SNM:

Sacral neuromodulation

SPMS:

Secondary progressive multiple sclerosis

TUR-P:

Transurethral resection of the prostate

UDS:

Urodynamic study

UI:

Urinary incontinence

UK:

United Kingdom

UTIs:

Urinary tract infections

UUI:

Urge urinary incontinence

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Authors and Affiliations

  1. 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Petros Georgopoulos, Konstantinos-Vaios Mytilekas & Apostolos Apostolidis

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  1. Petros Georgopoulos
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  1. Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA

    Roger Dmochowski

  2. Department of Urology, Radboud University, Nijmegen, The Netherlands

    John Heesakkers

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Georgopoulos, P., Mytilekas, KV., Apostolidis, A. (2018). Degenerative Diseases (Multiple Sclerosis, Parkinson’s Disease). In: Dmochowski, R., Heesakkers, J. (eds) Neuro-Urology. Springer, Cham. https://doi.org/10.1007/978-3-319-90997-4_5

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