Bladder dysfunction in parkinson's disease: An updated review and guide for the urologist.

Abstract

Purpose: Bladder dysfunction(BD) is a common and debilitating manifestation of Parkinson's Disease(PD). However, guidelines for its management are lacking. We aim to address key bladder dysfunction issues that a urologist faces when managing PD patients.

Methods: BD issues in PD patients were identified by expert opinion. We discussed the available literature and the recommended management for each of the identified issue.

Results: Anticholinergics are traditionally first-line for overactive bladder (OAB) management; however, beta-3 agonists should instead be considered first-line therapy to reduce anticholinergic burden. Onabotulinum toxin-A is safe for PD patients, and we recommend a starting dose of 100IU. When comparing PD and Multiple System Atrophy (MSA), detrusor sphincter dyssynergia and high post void residual (PVR) strongly favour MSA, whereas detrusor overactivity with minimal PVR is more typical in PD. Surgery for bladder outflow obstruction is safe in PD patients, but should be avoided in MSA. Urodynamics should be considered prior to surgery. If diagnosis is unclear between PD and MSA, a neurologist should be consulted. Management of nocturia, functional incontinence and falls should include optimisation of PD management, environmental factors and standard OAB options. Orthostatic hypotension is common in PD and Midodrine, the treatment of choice, can cause bladder outlet obstruction(BOO). If this occurs, patients should consult their neurologist about an alternative medication. Alternatively, they can start 5-alpha reductase therapy, consider catheterisation or BOO surgery.

Conclusion: Managing a PD patient's urological issues can be challenging. This article is an updated and comprehensive review of bladder dysfunction and its management in PD patients.