[Vesical sphincter disorders in Parkinson disease]

Urinary bladder disorders often occur, sometimes very early, during the course of Parkinson's disease. Careful analysis of symptoms including clinical examination, urodynamic studies and radiographic data is essential before choosing a treatment, especially before prostatic surgery. We studied 41 parkinsonian patients. Bladder hyperreflexia occurred in 88% and bladder hyporeflexia in only 12%. In 16 patients, we tested bladder activity after a subcutaneous injection of apomorphine. All patients with hyperreflexia were improved whereas hyporeflexic patients remained unchanged. These findings and data from the literature suggest that in Parkinson's disease detrusor hyperreflexia is the consequence of dopamine nigrostriatal depletion. The physiopathology of bladder hyporeflexia is less understood. The practical care of parkinsonians with urinary disorders is detailed.