Bladder dysfunction in advanced Parkinson's disease

Parkinson's disease (PD) patients often have lower urinary tract symptoms. Seventy-four percent of patients with early-to-moderate disease report more than one bladder disturbance symptom. Severe bladder symptoms are reported in 27-39% of PD patients. The aim of this study was to evaluate the severity of bladder dysfunction in patients with advanced PD.

Patients were enrolled from a cohort with advanced PD. We compared patients receiving oral medications only, with patients treated using either deep-brain stimulation (DBS) in the subthalamic nucleus, or with an apomorphine pump. One hundred seven patients were evaluated using two sets of validated questionnaires [Danish Prostate Symptom Score (DanPSS) and the International Prostate Symptom Score (IPSS)] about bladder symptoms. Postmicturitional residual urine was recorded.

There were no statistically significant differences between the treatment groups on the total DanPSS or IPSS scores. Bladder symptom severity correlated to the stage of disease (conventional treatment: r = 0.364, P = 0.004, apomorphine: r = 0.73, P = 0.02), except for patients treated with DBS, whereby symptom severity correlated to DBS duration (r = 0.34, P = 0.038). Patients treated with DBS had significant less nocturia compared to the other groups (P = 0.007).

Lower urinary tract symptoms are highly prevalent in patients with advanced PD. More than 50% of patients have severe bladder symptoms, most frequently symptoms of overactive bladder. Patients treated with DBS in the STN had the same amount of LUTS symptoms as patients treated with either conventional oral medication therapy or an apomorphine pump, but exhibited significantly less nocturia.