From the Guidelines
Urodynamic findings in Parkinson's disease patients typically include detrusor overactivity, bladder outlet obstruction, and detrusor underactivity, and management should be guided by the most recent and highest quality evidence, such as the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction 1. The common urodynamics findings in patients with Parkinson's disease include:
- Detrusor overactivity
- Bladder outlet obstruction
- Detrusor underactivity Management options for urinary symptoms in these patients include:
- Behavioral modifications, such as timed voiding and fluid restriction
- Pharmacotherapy with antimuscarinic medications, like oxybutynin (5mg 2-3 times daily), solifenacin (5-10mg daily), or tolterodine (2-4mg daily) 1
- Beta-3 agonists, such as mirabegron (25-50mg daily), which are effective alternatives with fewer cognitive side effects, particularly important in Parkinson's patients who may already have cognitive impairment 1
- Alpha-blockers, like tamsulosin (0.4mg daily), for patients with bladder outlet obstruction
- Clean intermittent catheterization for patients with detrusor underactivity It's essential to consider drug interactions between urologic medications and Parkinson's medications, particularly the anticholinergic burden that may worsen cognitive function, as highlighted in the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation 1. Regular reassessment is necessary as urinary symptoms often progress with the underlying disease, and urodynamic testing provides an objective assessment of bladder function, helping guide appropriate therapy selection based on the specific dysfunction present, as recommended in the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up 1.
From the Research
Urodynamics Findings in Parkinson's Disease
- The most common urodynamics findings in patients with Parkinson's disease include detrusor overactivity (DO), which is reported in 45-93% of patients 2.
- Other common findings include bladder outlet obstruction, detrusor underactivity, stress incontinence, increased bladder sensation, and an acontractile bladder 3.
- Urinary symptoms such as urgency, frequency, nocturia, and urge incontinence are frequently present in patients with Parkinson's disease, with nocturia being the most common complaint in >60% of patients 2.
Management Options for Urinary Symptoms
- Pharmacologic interventions, such as anticholinergic medications, are the first-line option for treating overactive bladder (OAB) in patients with Parkinson's disease 4.
- Other treatment options include intra-detrusor Botulinum toxin injections, electrical stimulation, and mirabegron, a β3-agonist with superior tolerability to anticholinergics 4.
- Desmopressin is effective for the management of nocturnal polyuria, which is common in Parkinson's disease patients 4.
- Deep brain stimulation (DBS) surgery has been shown to improve urinary functions in Parkinson's disease patients 4, 5.
Importance of Urodynamic Evaluation
- Urodynamic evaluation is essential for determining the underlying bladder disorder and selecting the most appropriate treatment option 4, 2, 5.
- Urodynamic testing can help identify patients with detrusor overactivity, bladder outlet obstruction, and other bladder disorders, allowing for personalized management 3.
- Collaboration between urologists and neurologists is highly recommended to maximize a patient's bladder-associated quality of life 5.