For the general urologist and neurourologist alike, the subtleties between Parkinson’s disease (PD) and other gait disorders can be difficult to discern. For decades, transurethral resection of the prostate was thought to be contraindicated in PD due to risk of incontinence complications. It’s now known that there’s no contraindication if multisystem atrophy is excluded. Similarly, the relationship between new pharmaceuticals for lower urinary tract symptoms and those used to treat movement disorders may not be familiar to practitioners. A recent review article, A Guideline for the Management of Bladder Dysfunction in Parkinson’s Disease and Other Gait Disorders (Sakakibara et al, Neurourology and Urodynamics, on line 25 March 2015) is a comprehensive review of lower urinary tract dysfunction in Parkinson’s disease. The review covers the basic science behind neural control of micturition relevant to PD, epidemiology, clinical symptoms, urodynamics testing and treatment as well as clinical overlap with other gait disorders.
Parkinson’s disease is the second most common neurodegenerative condition in the elderly. Lower urinary tract symptoms (LUTS) occur in up to 75% of patients, overactive bladder (OAB) being the most common. Voiding symptoms are also common and frequently overlap with benign prostatic hypertrophy (BPH) in older men. Dopaminergic medications to treat PD can improve or worsen LUTS in PD. Anticholinergics for OAB do not interact negatively with dopaminergic agents, but must be used with caution in the elderly. This review offers a detailed discussion of these medications, as well as that of newer agents for the treatment of OAB symptoms: β3 agonists, botulinum toxin and percutanous tibial nerve stimulation.
This review presents the clinician’s challenge in distinguishing LUTS from PD versus benign prostatic hypertrophy. There is also an excellent discussion of distinguishing features of PD and multisystem atrophy, along with treatment algorithms for urologic symptoms in each. Especially helpful are the clinical flow charts in Appendix 1 and 2 which provide a desktop reference when managing these patients.
Article by the Publications and Communications Committee
A Guideline for the Management of Bladder Dysfunction in Parkinson’s Disease and Other Gait Disorders, Sakakibara et al, Neurourology and Urodynamics, on line 25 March 2015