Summary Parkinson’s disease (PD) is recognized as the most common neurodegenerative disorder after Alzheimer’s disease. Lower urinary tract symptoms are common in patients with PE, either storage symptoms (overactive bladder or OAB symptoms) or voiding symptoms. The most important diagnostic clues for urinary disorders are provided by the patient’s clinical history . Urodynamic evaluation can determine the underlying bladder disorder and may assist in treatment selection. Pharmacological interventions , especially anticholinergic medications, are the first-line option to treat overactive bladder in patients with PD. However, it is important to balance the therapeutic benefits of these drugs with their potential adverse effects.
Pathological hypersexuality has occasionally been reported in PD patients, related to dopamine agonists. The first step in the treatment of hypersexuality is to reduce the dose of dopaminergic medication. |
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A review expanded on the urologic complications associated with Parkinson’s disease (PD), as well as therapies for these complications.
Parkinson’s disease (PD) is recognized as one of the most common neurodegenerative disorders after Alzheimer’s disease. A review published in Archives of Italian Urology and Andrology expanded on the urological complications associated with PE, as well as the therapies for these complications.
Lower urinary tract symptoms, including storage or emptying symptoms, are common among patients with Parkinson’s disease, and 74% of patients with early to moderate disease report more than one symptom of bladder disturbance.
In this review, data from a total of 90 articles were included.
The authors first noted that a patient’s medical history is the most important tool in determining any urinary disorder, which could help with treatment selection.
When it comes to treatment, the authors said that pharmacological interventions, particularly anticholinergic medications , are the first-line option for treating overactive or storage bladder (OAB) symptoms in patients with PD. However, potential adverse events need to be taken into account when measuring the potential benefits of any treatment.
In cases of OAB with superior tolerability to anticholinergic medications, the β3 agonist mirabegron may also be used. Although they are known to lack the side effects typical of antimuscarinic agents, only a few trials have tested their effectiveness in PD patients.
Due to their limited efficacy data, dopaminergic therapy or L-dopa medication and botulinum toxin (BT) injections have been mentioned as treatments for PD but are still being investigated.
While some studies reported that L-dopa improves urination symptoms, other studies had conflicting results. For botulinum toxin injections, the guidelines emphasized the importance of differentiating multiple system atrophy (MSA) from PD before completing injections, but did not include recommendations on dosing, long-term efficacy, and risk factors for retention. or difficulty emptying.
Desmopressin was also found to be effective for the treatment of nocturnal polyuria.
“The use of antimuscarinics, detrusor BT injection, neuromodulation, and CIC [clean intermittent catheterization] could be useful in managing reduced bladder capacity,” the authors said. “Desmopressin and evening diuretics could help in the management of nocturnal polyuria.”
Aside from pharmacological treatments, behavioral therapy should also be considered as an initial treatment for overactive bladder, especially to treat early and advanced PE, the authors noted.
Additionally, deep brain stimulation (DBS) surgery, which has been used as a treatment for motor symptoms in advanced PD, has been shown to be effective in improving urinary functions in PD patients.
"DBS is associated with increased bladder capacity and volume triggering bladder contraction, increased time to first desire to urinate," the authors said. “While DBS appears to be a promising therapy for modulating LUTS [lower urinary tract symptoms] in patients with PD, current research is primarily limited to small cohorts.”
In general, many treatments require larger clinical trials to demonstrate their effectiveness. However, treatments such as anticholinergics and mirabegron remain potential treatment options for PD.
“Treatment of all urological dysfunction in PD is optimal with a multidisciplinary approach to improve the quality of life of these patients,” the authors concluded.
Conclusions
Urinary symptoms and sexual dysfunctions are common in PD patients and occur at any stage of the disease. Patients with PD experience both storage and evacuation difficulties. Storage symptoms, specifically OAB, are very common in these patients. Anticholinergics and mirabegron remain possible treatment options. DBS, intradetrusor botulinum toxin injections can be used to treat intractable OAB symptoms in PD. TURP could be safely performed in PD patients with BPH if MSA is excluded. Other non-pharmacological supportive therapies, such as behavioral therapy, are used in patients with early and advanced PD. Phosphodiesterase-5 inhibitors are essential to treat sexual dysfunction. The treatment of all urological dysfunction in PD is optimal with a multidisciplinary approach to improve the quality of life of these patients.
