Urologic Symptom Management in Parkinson's Disease - Current Treatments and Emerging Directions - Systematic Review

This review synthesizes current evidence on therapeutic strategies for Parkinson's disease (PD)-related overactive bladder (OAB), encompassing PD-targeted treatments, pharmacologic interventions, and advanced therapies such as neuromodulation and intravesical botulinum toxin. We address the complexity of managing lower urinary tract symptoms (LUTS) in patients with PD due to progressive neurodegeneration affecting micturition control and cognitive vulnerabilities in this population.

A thorough review of available literature shows that chronic levodopa improves bladder capacity and reduces urgency, though acute dosing may worsen symptoms in advanced stages. Subthalamic nucleus-deep brain stimulation enhances bladder function and symptom scores, possibly by modulating basal ganglia-thalamocortical circuits. Anticholinergics are effective but pose cognitive risks, warranting careful use guided by anticholinergic burden assessments. In contrast, beta-3 agonists such as mirabegron offer a safer cognitive profile with emerging efficacy data. Finally, intravesical botulinum toxin and neuromodulation present promising third-line options, though data in PD remain limited, and larger trials are still needed to confirm their role. Optimal management of LUTS in PD requires individualized, stage-specific, multidisciplinary strategies balancing efficacy and cognitive safety. Further high-quality, disease-specific studies are essential to develop tailored treatment algorithms and improve quality of life in this growing patient population.