[Bladder sphincter disorders in Parkinson's disease].

Area of Science:

• Neurology
• Urology

Context:

• Parkinson's disease (PD) involves extrapyramidal degeneration, leading to tremors, rigidity, and akinesia.
• Neurovegetative disorders, including bladder and sexual dysfunction, are common in PD patients.
• Bladder dysfunction occurs in 30-90% of PD cases, varying with disease stage.

Purpose:

• To review the pathophysiology and management of bladder dysfunction in Parkinson's disease.
• To analyze current literature on urodynamic findings and treatment efficacy in PD-related lower urinary tract symptoms.

Summary:

• Dopamine deficiency in Parkinson's disease may cause bladder hyperreflexia and irritative voiding symptoms.
• Urodynamic findings are conflicting, with most studies reporting bladder overactivity, though some indicate hypoactivity.
• Bladder sphincter dyssynergia is debated, with most studies showing synergistic micturition.
• L-dopa effects on bladder function are inconsistent; anticholinergics help overactive bladder, and alpha-blockers address urethral hypertonia.
• Prostatic surgery requires careful consideration due to high post-operative incontinence risk; endourethral prostheses offer an alternative for obstruction.

Impact:

• Highlights the complexity of managing bladder issues in Parkinson's disease patients.
• Emphasizes the need for thorough clinical and urodynamic assessment before surgical intervention.
• Suggests alternative treatments like endourethral prostheses for specific cases of prostatic obstruction.