Effects of Nonpharmacological and Nonsurgical Intervention for Lower Urinary Tract Symptoms in Parkinson's Disease: A Systematic Review and Meta-analysis

Lower urinary tract symptoms (LUTS) are common in Parkinson's disease (PD) and reduce quality of life. We assessed whether nonpharmacological and nonsurgical (NPNS) interventions improve PD-related LUTS.

We searched PubMed, CENTRAL, PEDro, and CINAHL from inception to November 28, 2025, and screened reference lists. Randomized controlled trials (RCTs) and nonrandomized studies in adults with PD comparing NPNS interventions with no intervention, sham/placebo, or usual care were eligible. Primary outcomes were 24-h bladder-diary episodes (voids, urgency, incontinence). Secondary outcomes were validated symptom, bother, and urinary-related quality-of-life (QOL) scales. Random-effects meta-analyses used postintervention values. Risk of bias (RoB) was assessed with Cochrane RoB 2/RoB Assessment Tool for Non-randomized Studies, and certainty with the Grading of Recommendations, Assessment, Development and Evaluations approach.

Sixteen studies were included (13 RCTs, two nonrandomized studies, one case study). Urinary incontinence episodes decreased modestly (mean difference -0.91 episodes/24 h, 95% confidence interval -1.74 to -0.08; moderate certainty). For urgency episodes, symptom scores, and bother scores, estimates suggested possible benefit but were imprecise (low certainty). Effects on voiding frequency, urinary-related QOL, and the non-motor symptoms scale urinary domain were highly uncertain (very low certainty). Many outcomes showed substantial heterogeneity; pooled estimates should be interpreted as conditional summaries. Publication bias could not be assessed because most meta-analyses included fewer than 10 studies.

NPNS interventions may improve some LUTS outcomes in PD, with the most consistent signal for urinary incontinence. More adequately powered trials enrolling patients with confirmed LUTS and using standardized LUTS-specific outcomes, follow-up, and comparator definitions are needed.