Urinary dysfunction in Parkinson’s disease patients

Abstract

Background: Autonomic nervous system dysfunction that affects 70–80% of Parkinson’s disease (PD) patients, causes significant morbidity and it is correlated with poor quality of life. Objective: We assessed in a consecutive series of PD patients frequency of autonomic symptoms by means of the Scale for Outcomes for Parkinson’s disease AUTonomic (SCOPA-AUT) and we correlated it with the results of noninvasive urological studies (nUS). Methods: PD patients with known conditions that might have influenced urinary function were excluded. Clinical assessment of PD patients included the H&Y staging, UPDRS, BDI, NPI, PDQ- 39, PDSS, ESS, and the SCOPA-AUT scale. nUS consisted of uroflowmetry and ultrasound of the urinary tract with measurement of postvoid residual (PVR) urine volume. The quantitative parameters measured during the voiding phase included maximum flow rate (Qmax) and postvoid residual (PVR). Results: 45 PD patients (26 males and 19 females) were included (mean age at interview 62.1 ± 10.6; mean disease duration: 6.5 ± 4.3 years). PD patients had a mean SCOPA-AUT score of 14.1 ± 7.1. PD patients with urinary dysfunction, had higher SCOPA-AUT scale score, longer disease duration and an higher dosage of levodopa calculated as levodopa equivalent dose (LED). At least one clinical symptom of dysautonomia was found in all of our PD patients and urinary symptoms were the most common complain (92.8%). The mean Qmax was 17.9 ml/s (SD 9.1 ml/s), and the mean PVR was 33.7 ml (SD 68.7 ml), with no patient having a PVR>200 ml. Ultrasound documented possible causes of urinary disorders in 44% of patients (prostate hypertrophy was observed in 11 of 26 males). Conclusion: Our findings suggest that urinary symptoms and abnormal findings in nUS are common in PD patients. The autonomic dysfunction might be related to nigrostriatal degeneration, though urinary dysfunction in patients PD could be, especially in males,attributed to other conditions