[Bladder sphincter disorders in Parkinson's disease]

Clinical and urodynamic examinations were carried out in 63 patients with Parkinson's disease presenting with disorders of the urinary bladder sphincters with no detectable other neurological or urological cause. The incidence of these disorders varies greatly according to different authors this being likely due to a lack of their recognition in routine examinations. In many cases of the present series they were the initial symptom of the disease. The most frequent complaint was urgency of micturition, alone or associated with dysuria, the latter alone being much rarer. Urinary incontinence as a result of one or the other of these disturbances was a frequent feature. Overall clinical characteristics confirm the central neurologic origin of these disorders. Cystometry demonstrated detrusor hyperactivity in 60 p. cent of cases and hypoactivity in 35 p. cent. An electromyogram of the striated sphincter muscle and/or a urethral pressure graph were recorded in some patients. On the whole urodynamic data indicated detrusor muscle dysfunction as being the cause of the micturition disorders. L-Dopa could modify these disorders by increasing detrusor hypoactivity, probably through a central action. Anticholinergic agents provided good therapeutic results when detrusor hypoactivity was involved but it was much more difficult to improve hypoactivity. Data suggesting the role of basal ganglia lesions in detrusor dysfunction in Parkinson's disease are discussed.