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International Journal of Urology (2012)

doi: 10.1111/j.1442-2042.2012.03220.x

Review Article

Effective management of lower urinary tract dysfunction in
idiopathic Parkinson’s disease
Sona Kapoor, Andreas Bourdoumis, Lewis Mambu and Jayanta Barua
Urology Department, King George Hospital, Barking, Havering and Redbridge University Teaching Hospitals NHS Trust, Essex, UKAbbreviations & Acronyms
DO = detrusor overactivity
EMG = electromyogram
LUT = lower urinary tract
LUTS = lower urinary tract
symptoms
MSA = multiple system
atrophy
NLUTD = neurogenic
lower urinary tract
dysfunction
PD = Parkinson’s disease
PMC = pontine micturition
center
TURP = transurethral
resection of prostate

Abstract: Parkinson’s disease, also known as paralysisagitans, is a progressive
degenerative disorder of the central nervous system, with onset usually between the
ages of 50 and 65 years, and is associated with loss of dopaminergic neurons in the
subsantia nigra and the presence of Lewy bodies. It is characterized by the triad of
resting tremor, muscular rigidity and bradykinesia. Often-accompanying abnormalities
include disorders of equilibrium,posture and autonomic function, including micturition.
Symptoms from the lower urinary tract add a significant comorbidity factor in these
patients. The incidence and prevalence of lower urinary tract dysfunction rise with
increasing progression of the underlying neurological disease. They present a troublesome and difficult to treat health issue with a profound impact on the patient’s quality oflife. Storage symptoms seem to predominate. In the long term, renal function might be
compromised, mainly as a result of elevated intravesical pressure. Various conservative,
minimally-invasive and surgical treatment options are available to prevent harmful
sequelae, and to improve the quality of life of these patients. We present an overview of
current and prospective treatment strategies.Correspondence: Sona Kapoor
M.R.C.S., Urology Department,
King George Hospital, Barking,
Havering and Redbridge
University Teaching Hospitals
NHS Trust, Barley Lane, Ilford,
Essex IG3 8YB, UK. Email:
sona@doctors.org.uk

Key words: bladder dysfunction, management, multiple system atrophy, parkinsonism, urinary symptoms.

Received 1 August 2012;
accepted 30 September 2012.

PrevalenceIn the literature, the incidence of NLUTD in PD ranges between 37.9–70% of patients.1–3 In
an older study, Gray et al. reported that functional disturbances of the lower urinary tract in
PD were not disease-specific and were correlated only with age.4 Recent, control-based
studies in patients with PD have given the prevalence of LUT symptoms as 27–63.9% using
validated questionnaires,5–7 or53% in men and 63.9% in women, with all of these values
being significantly higher than in healthy controls. Ransmayr reported a prevalence of urge
episodes and urge incontinence in 53% of Lewy body patients and detrusor overactivity in
46%.8 In a recent study evaluating disease severity and its relation to urodynamic parameters,9 the most prevailing symptom was nocturia, followed by urgency andfrequency. In
most patients, the onset of the bladder dysfunction occurs after the motor disorder had
appeared. It has also been shown that voiding dysfunction increases with neurological
impairment and not with patient’s age or disease duration.10

Pathophysiology
Several key features have to be taken into account when trying to interpret the mechanisms
behind urinary symptoms in PD. Thelower urinary tract is subject to supraspinal control. In
general, lesions to the PMC frequently result in detrusor hyper-reflexia through loss of the
tonic inhibition reflex contraction of the detrusor. This results in DO with normal sphincter
tone and sensation. Coordination between detrusor and sphincter is preserved. As a consequence, storage symptoms (frequency, urgency and nocturia) might...