Urological problems in Parkinson's disease: clinical aspects
1Department of Neurology, Deutsche Klinik für Diagnostik, Aukammallee 33, 65191, Wiesbaden, Germany. jost.neuro@dkd-wiesbaden.de
Journal of Neural Transmission (Vienna, Austria : 1996)
|December 1, 2012
Summary
Overactive bladder is a common Parkinson's disease symptom impacting bladder control. Treatments like anticholinergics help manage symptoms, but new options like botulinum toxin show promise.
Area of Science:
- Neurology
- Urology
Background:
- Bladder dysfunction, particularly overactive bladder, is prevalent in Parkinson's disease (PD) and worsens with disease progression.
- Bladder control involves complex interactions between central nervous system centers and the spinal cord, with dopamine playing a key inhibitory role.
Purpose of the Study:
- To outline the pathophysiology of bladder dysfunction in Parkinson's disease.
- To discuss diagnostic approaches and therapeutic strategies for managing overactive bladder in PD patients.
Main Methods:
- Review of the neuroanatomy and neuropharmacology of bladder regulation.
- Analysis of clinical presentation, diagnostic methods, and pharmacological treatments for overactive bladder in PD.
- Exploration of emerging therapeutic options.
Main Results:
- Overactive bladder in PD stems from reduced central inhibition, leading to detrusor muscle overactivity and symptoms like urinary urgency and incontinence.
- Medical history is crucial for diagnosis; urodynamic studies are rarely needed.
- Anticholinergic medications (e.g., tolterodine, solifenacin, darifenacin) are primary treatments, with caution regarding cognitive side effects.
Conclusions:
- Effective management of overactive bladder in Parkinson's disease requires a focus on controlled bladder evacuation and continence.
- Current anticholinergic therapies offer limited efficacy and potential cognitive risks.
- Local botulinum toxin injections represent a promising, though currently unapproved, alternative treatment.
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