Genitourinary dysfunction in Parkinson's disease

Abstract

Bladder dysfunction (urinary urgency/frequency) and sexual dysfunction (erectile dysfunction) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, genitourinary autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the genitourinary dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life.2010 Movement Disorder Society

Diagnósticos de Enfermagem sobre alterações urinárias na doença de Parkinson

“…In these studies, there was no discrimination of different types of bladder changes. (2,3) "Urge Urinary Incontinence" was considered a specific diagnosis and, according to the publications on the subject, is related both to own Parkinson's disease due to overactivity of the detrusor muscle of the bladder, as other causes, such as idiopathic presentation seen in men and women aged over 65 years, due in part of latent cerebral ischemia. (3) The Nursing Diagnosis "Overflow urinary incontinence", identified in the survey reaffirmed the multiple causes of bladder symptoms in patients with Parkinson's.…”

“…(2,3) "Urge Urinary Incontinence" was considered a specific diagnosis and, according to the publications on the subject, is related both to own Parkinson's disease due to overactivity of the detrusor muscle of the bladder, as other causes, such as idiopathic presentation seen in men and women aged over 65 years, due in part of latent cerebral ischemia. (3) The Nursing Diagnosis "Overflow urinary incontinence", identified in the survey reaffirmed the multiple causes of bladder symptoms in patients with Parkinson's. Overflow urinary incontinence, was associated to men with benign prostatic hyperplasia, which is a chronic, complex, progressive disease and which is related to lower urinary tract symptoms, in addition to affecting the quality of life of affected patients.…”

“…The selection of the signs and symptoms reported by patients should be made in detail, both for planning of the treatment as well as to guide the clinical reasoning of nurses. (3) Currently, studies related to urinary disorders in individuals with PD focus mostly on pharmacological treatment, such as the use of anticholinergic medications and alpha blockers. (3) However, there are few studies that address the nurse in relation to differential nursing diagnosis or to substantiate the conduct of nursing professionals.…”

“…(3) Currently, studies related to urinary disorders in individuals with PD focus mostly on pharmacological treatment, such as the use of anticholinergic medications and alpha blockers. (3) However, there are few studies that address the nurse in relation to differential nursing diagnosis or to substantiate the conduct of nursing professionals. (1,4) The term "differential diagnosis" leads to the context of the nursing process and the use of standardized language, through a selected classification system.…”

Non-motor Symptoms in Parkinson’s Disease

“…[101][102][103] These rates tend to be lower if MSA has been carefully eliminated from the study population, as LUTS are found in nearly all MSA patients. 104 The most widely accepted theory explaining LUTS pathogenesis in PD is that the loss of basal ganglia neurons disrupts normal inhibition of the micturation reflex (located in the pontine micturation center), mediated by D1 receptors.10 5 This loss of reflex inhibition leads to an unstable bladder, resulting in the urgency and frequency symptoms most often described by PD patients. This theory is supported by reports of improved LUTS after DBS of the subthalamic nucleus.…”