From the Guidelines
Management of a patient with Parkinson's disease and abnormal urodynamics findings should prioritize a tailored approach based on specific urinary symptoms, incorporating non-surgical and surgical options as necessary, with a focus on risk stratification and follow-up. The treatment plan may involve a combination of pharmacological and non-pharmacological interventions. According to the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction 1, patients may undergo various treatment options depending on their level of risk, symptoms, and urodynamic findings.
Key considerations in managing these patients include:
- Anticholinergic medications, such as oxybutynin or solifenacin, to address detrusor overactivity, but their use should be cautious due to potential cognitive side effects and worsening of constipation.
- Mirabegron, a beta-3 adrenergic agonist, as an alternative with fewer cognitive effects.
- Alpha-blockers, like tamsulosin, for patients with incomplete bladder emptying to reduce outlet resistance.
- Intermittent catheterization for significant post-void residual volumes.
- Optimization of deep brain stimulation settings, as they can affect bladder function.
- Non-pharmacological approaches, including timed voiding, pelvic floor exercises, and fluid management.
For refractory cases, botulinum toxin injections into the detrusor muscle or neuromodulation therapy may be considered. Regular reassessment of treatment is crucial as Parkinson's disease progresses and urinary symptoms evolve, emphasizing the importance of follow-up based on risk stratification, as recommended by the guideline 1.
From the Research
Urodynamics Findings in Parkinson's Disease
- Urodynamics findings in patients with Parkinson's disease (PD) often show detrusor overactivity (DO) and overactive bladder (OAB) symptoms 2, 3
- The post-void residual (PVR) volume is typically minimal in PD patients, which differs from patients with multiple system atrophy (MSA) who often experience urinary retention 2
- Subclinical detrusor weakness during voiding may also occur in PD patients 2
Management Options for Abnormal Urodynamics Findings
- Anticholinergics can be used as an add-on therapy to manage LUTS in PD patients 2
- Beta-3 adrenergic agonists are a potential treatment option with minimal central cognitive side effects 2
- Deep brain stimulation (DBS) may improve bladder dysfunction in PD patients 2, 4
- Botulinum toxin injections can be used to treat intractable urinary incontinence in PD patients 2
- Transurethral resection of the prostate gland (TURP) is not contraindicated in PD patients with comorbid benign prostatic hyperplasia (BPH) if MSA is excluded 2
Importance of Collaboration and Referral
- Collaboration between urologists and neurologists is highly recommended to maximize a patient's bladder-associated quality of life 2
- Referral to a urologist is advised for patients with persistent or refractory urinary complaints 3
- Urodynamic evaluation can help determine the underlying bladder disorder and guide treatment decisions 3