Functional disorders of the lower urinary tract: Parkinson's disease

Abstract

Parkinson's disease (PD) is a common neurodegenerative disease that is associated with considerable socioeconomic burden. Due to neurogenic detrusor overactivity, which challenges more the urinary storage phase than the voiding phase, these patients mainly suffer from urinary urgency, increased urinary frequency (both during the day-time and particularly at night-time), and incontinence. Besides dopaminergic agents, which have an effect on motor symptoms but only a slight effect on lower urinary tract dysfunction (LUTD), antimuscarinics are generally used as first-line treatment. However, treatment benefit is limited by central side effects (i.e., dry mouth, constipation, cognitive impairment), which occur in approximately 60% of treated PD patients. Moreover, simultaneous supplementation of antimuscarinics and PD medication is limited by negative interactions. Intradetrusor onabotulinumtoxin A (OnabotA) injections have emerged as an effective, minimally invasive, well-tolerated, and widely accepted treatment for refractory neurogenic detrusor overactivity incontinence. Recently, intradetrusor OnabotA injections were noted to effectively alleviate detrusor overactivity in patients with spinal cord injury and multiple sclerosis. Intradetrusor OnabotA injections seem to effectively alleviate LUTD in patients diagnosed with PD, while maintaining voluntary voiding.

Keywords: Bladder dysfunction; Botulinum toxins; Myelodysplasia; Urge urinary incontinence; Urodynamics.

Knüpfer SC. Funktionsstörungen des unteren Harntrakts: Morbus Parkinson [Functional disorders of the lower urinary tract: Parkinson's disease]. Urologie. 2025 Feb 3. German. doi: 10.1007/s00120-024-02508-y. Epub ahead of print. PMID: 39900843.