Urological dysfunction

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Symptoms of urinary dysfunction occur frequently in patients with Parkinson's disease (PD), particularly men. Irritative symptoms, such as frequency, urgency, and urge incontinence, are reported in 57-83% of patients with PD. Obstructive symptoms, such as hesitancy and weak urinary stream, may be present in 17-36% of individuals. The appearance of urinary symptoms may follow the appearance of motor symptoms by a few years. Several mechanisms, such as detrusor hyperre flexia, detrusor are flexia, coexistent obstructive uropathies, and dysfunction of infravesical mechanisms, can be responsible for the urinary dysfunction in patients with PD. Detrusor hyperre flexia is the urodynamic correlate of irritative urinary symptoms. Detrusor are flexia is uncommon in PD and, when present, is usually secondary to the use of anticholinergic medications. Coexistent obstructive uropathies may complicate the clinical picture in patients with PD and produce both obstructive and irritative symptoms. Urinary dysfunction in PD also may be the result of dysfunctional infravesical mechanisms such as sphincter bradykinesia. In terms of pathogenesis, voiding dysfunction in PD is primarily due to the loss of the inhibitory effect that the basal ganglia exert on the pontine micturition center. This inhibitory effect likely is mediated by D1 dopamine receptors and results in a "quiet bladder" during the filling phase. In terms of treatment, the irritative symptoms often can be treated successfully with anticholinergic drugs; however, for refractory overactive bladder, intravesical botulinum toxin injections or deep brain stimulation surgery may be required. If the symptoms are obstructive in nature, bladder catheterization and sometimes urological surgery may be necessary.

Original languageEnglish (US)
Title of host publicationParkinson's Disease and Nonmotor Dysfunction
Subtitle of host publicationSecond Edition
PublisherHumana Press Inc.
Pages187-200
Number of pages14
ISBN (Electronic)9781607614296
ISBN (Print)9781607614289
DOIs
StatePublished - Jan 1 2013

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Keywords

  • Anticholinergics
  • Basal ganglia
  • Biofeedback
  • Botulinum toxin
  • Cystometrogram
  • Cystostomy
  • Darifenacin
  • Deep brain stimulation
  • Detrusor
  • Detrusor areflexia
  • Detrusor hyperreflexia
  • Detrusor re flex
  • Dopamine
  • Dopamine agonists
  • Dysfunctional infravesical mechanisms
  • Erectile dysfunction
  • Flavoxate
  • Hoehn and Yahr
  • Hyoscyamine
  • Intermittent catheterization
  • Involuntary detrusor contraction
  • Irritative
  • Levodopa
  • Lower urinary tract symptoms
  • Mean maximum cystometric capacity
  • Multiple system atrophy
  • Myogenic are flexia
  • Neurogenic bladder
  • Obstructive
  • Obstructive uropathy
  • Onuf's nucleus
  • Oxybutynin
  • Oxybutynin LA
  • Parkinson's disease
  • Percutaneous posterior tibial nerve stimulation
  • Periaqueductal gray matter
  • Pontine micturition center
  • Pontine storage center
  • Positron emission tomography
  • Postvoid residual volume
  • Propantheline bromide
  • Pseudodyssynergia
  • Repetitive transcranial magnetic stimulation
  • Solifenacin
  • Sphincter bradykinesia
  • Sphincter EMG
  • Sphincter tremor
  • Subthalamic nucleus
  • Thalamotomy
  • Tolterodine
  • Tolterodine LA
  • Transurethral prostatectomy
  • Trospium chloride
  • Trospium XR
  • Urge incontinence
  • Urge incontinence
  • Urgency
  • Urinary dysfunction
  • Urinary urgency
  • Urodynamic studies
  • Vesicosphincter dyssynergia
  • Voiding dysfunction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Moore, H. P., & Singer, C. (2013). Urological dysfunction. In Parkinson's Disease and Nonmotor Dysfunction: Second Edition (pp. 187-200). Humana Press Inc.. https://doi.org/10.1007/978-1-60761-429-6_12