Voiding Dysfunction in Parkinson's Disease

Sotolongo, Jose R.

doi:10.1055/s-2008-1041372

Cited by 16 publications

(9 citation statements)

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“…Anticholinergics constitute the mainstay initial treatment for severe storage symptoms, although altered mental status has to be taken into consideration. For those unable to tolerate the side‐effects, tricyclic antidepressants have shown to improve symptoms and quality of life . Alpha‐blockers have also been used successfully, but should be avoided in patients with MSA because of severe postural hypotension, a complication specific to this group.…”

Section: Resultsmentioning

confidence: 99%

“…It should be remembered that anticholinergics, especially when used in combination, might produce significant dry mouth, drowsiness, confusion and hallucinations. Imipramine, a tricyclic antidepressant, has been studied in the case of single anticholinergic agent failure, in combination, due to different receptor sites, and has been shown to improve symptoms in such patients. Anticholinergics might be used as initial treatment for patients with MSA as well.…”

Section: Treatmentmentioning

confidence: 99%

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Effective management of lower urinary tract dysfunction in idiopathic Parkinson's disease

et al. 2013

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Abbreviations & Acronyms DO = detrusor overactivity EMG = electromyogram LUT = lower urinary tract LUTS = lower urinary tract symptoms MSA = multiple system atrophy NLUTD = neurogenic lower urinary tract dysfunction PD = Parkinson's disease PMC = pontine micturition center TURP = transurethral resection of prostate Abstract: Parkinson's disease, also known as paralysis agitans, is a progressive degenerative disorder of the central nervous system, with onset usually between the ages of 50 and 65 years, and is associated with loss of dopaminergic neurons in the subsantia nigra and the presence of Lewy bodies. It is characterized by the triad of resting tremor, muscular rigidity and bradykinesia. Often-accompanying abnormalities include disorders of equilibrium, posture and autonomic function, including micturition. Symptoms from the lower urinary tract add a significant comorbidity factor in these patients. The incidence and prevalence of lower urinary tract dysfunction rise with increasing progression of the underlying neurological disease. They present a troublesome and difficult to treat health issue with a profound impact on the patient's quality of life. Storage symptoms seem to predominate. In the long term, renal function might be compromised, mainly as a result of elevated intravesical pressure. Various conservative, minimally-invasive and surgical treatment options are available to prevent harmful sequelae, and to improve the quality of life of these patients. We present an overview of current and prospective treatment strategies.Key words: bladder dysfunction, management, multiple system atrophy, parkinsonism, urinary symptoms. PrevalenceIn the literature, the incidence of NLUTD in PD ranges between 37.9-70% of patients. [1][2][3] In an older study, Gray et al. reported that functional disturbances of the lower urinary tract in PD were not disease-specific and were correlated only with age. 4 Recent, control-based studies in patients with PD have given the prevalence of LUT symptoms as 27-63.9% using validated questionnaires, 5-7 or 53% in men and 63.9% in women, with all of these values being significantly higher than in healthy controls. Ransmayr reported a prevalence of urge episodes and urge incontinence in 53% of Lewy body patients and detrusor overactivity in 46%. 8 In a recent study evaluating disease severity and its relation to urodynamic parameters, 9 the most prevailing symptom was nocturia, followed by urgency and frequency. In most patients, the onset of the bladder dysfunction occurs after the motor disorder had appeared. It has also been shown that voiding dysfunction increases with neurological impairment and not with patient's age or disease duration. 10 PathophysiologySeveral key features have to be taken into account when trying to interpret the mechanisms behind urinary symptoms in PD. The lower urinary tract is subject to supraspinal control. In general, lesions to the PMC frequently result in detrusor hyper-reflexia through loss of the tonic inhibition reflex contraction of the detr...

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Section: Resultsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Effective management of lower urinary tract dysfunction in idiopathic Parkinson's disease

et al. 2013

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“…Tension, g EFS frequency, Hz urination. It has been well documented that Parkinsonian patients with dysfunctions of dopaminergic neurones, which originate in the substantia nigra pars compacta and project to neostriatal neurones in the basal ganglia, produce urinary frequency and urgency [22,23]. These observations suggest that dysfunctions of dopaminergic neurones on the lesion side of RBF-lesioned rats may contribute to the frequent urination observed in this model.…”

Section: Fig 3 Contractile Responses To Efs ( a ) And Carbachol ( Bmentioning

confidence: 82%

Urodynamics in a rat neurogenic bladder model with a unilateral electrolytic lesion of the basal forebrain

et al. 2003

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OBJECTIVETo investigate the changes in bladder function in rats with an electrolytic lesion of the right basal forebrain (RBF) and to determine the effects of AH-9700, a novel sigma receptor ligand, on cystometry in RBF-lesioned rats. MATERIALS AND METHODSA lesion was made electrolytically in the RBF of male Wistar rats. At 7 or 8 days after the lesion or sham surgery, continuous cystometry was performed in awake rats. In addition, contractile responses to electrical field stimulation or carbachol were measured in isolated bladder strips, as were the forebrain contents of acetylcholine, monoamine neurotransmitters and their metabolites. RESULTSRBF-lesioned rats showed a remarkable increase in voiding frequency, with a decrease in voiding threshold pressure but no change in voiding pressure, compared with shamoperated rats. However, contractile responses in bladder strips isolated from RBF-lesioned rats were no different from those in strips isolated from sham-operated rats. In RBFlesioned rats, the contents of acetylcholine, dopamine, 4-dihidroxyphenylacetic acid and homovanillic acid were significantly decreased in the right forebrain. AH-9700 dose-dependently decreased the voiding frequency and increased the threshold pressure in RBF-lesioned rats. Antimuscarinic agents (oxybutynin and propiverine) also decreased the voiding frequency, but their effects were less potent than that of AH-9700. CONCLUSIONSThe RBF-lesioned rat may be a useful model for the neurogenic bladder of supraspinal origin. Moreover, AH-9700 effectively improves bladder dysfunction in this model.

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“…Ähnliche Phänomene werden auch von anderen Autoren beschrieben. So finden sich die Beschreibung einer verzögerten Relaxation mit einer outlet dysfunction (107,118) und einer Sphinkter-Bradykinese (10 I). Daneben wurden auch Detrusor-Sphinkter-Dyssynergien beschrieben, .was für eine zentrale, infrapontine Läsion spricht (101 ).…”

Section: Urogenitale Störungenunclassified

“…Inwieweit die Blasenstörungen mit der Ausprägung der Parkinson-Symptomatik korrelieren, ist nicht abschließend geklärt. Positive Korrelationen wurden jedoch bereits beschrieben (118). Ein Zusammenhang zu Geschlecht und Erkrankungsdauer konnte bisher nicht gefunden werden.…”

Section: Urogenitale Störungenunclassified

Autonome Regulationsstörungen beim Parkinson-Syndrom

Wh¹

1995

Fortschr Neurol Psychiatr

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Ever since the first description of Parkinson's disease, it has not only been associated with the classical triad of akinesia, rigor and tremor but also with autonomic regulation disorders. However, the studies published on this subject show differing and partly contradictory results. A large number of studies demonstrate a distinct autonomic disorder. On the other hand there are authors who question an affliction of the autonomic nervous system and others who attribute the autonomic disorder to Parkinson specific medication. To make matters worse, the various pathogeneses of Parkinson's syndrome within the patients collectives have not been sufficiently differentiated and nomenclature of the multisystem degeneration was handled in different ways. Taking our examinations of the various autonomic functions and the underlying literature into critical consideration, we come to the conclusion that regulation disorders of the cardiovascular system, gastrointestinal and urinary tract, as well as sweat and thermoregulation are often seen in the idiopathic Parkinson's disease. In our opinion the idiopathic Parkinson's syndrome must be attributed to the multisystem degenerations. Autonomic dysfunction occurs in different intensities in the disease.

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Voiding Dysfunction in Parkinson's Disease

Cited by 16 publications

References 0 publications

Effective management of lower urinary tract dysfunction in idiopathic Parkinson's disease

Effective management of lower urinary tract dysfunction in idiopathic Parkinson's disease

Urodynamics in a rat neurogenic bladder model with a unilateral electrolytic lesion of the basal forebrain

Autonome Regulationsstörungen beim Parkinson-Syndrom

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