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  • Review Article
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Prevalence and treatment of LUTS in patients with Parkinson disease or multiple system atrophy

Nature Reviews Urology volume 14, pages 79–89 (2017)Cite this article

Subjects

Key Points

  • Patients with Parkinson disease or multiple system atrophy (MSA) often have lower urinary tract symptoms such as urinary frequency and urinary incontinence

  • Antimuscarinic drugs are often used in patients with storage symptoms; however, these drugs might have adverse effects such as constipation, dry mouth and cognitive deterioration

  • Voiding difficulties owing to functional and/or mechanical outlet obstruction are also observed in both groups of patients

  • Conservative therapies for those with voiding dysfunctions include the administration of α-adrenoceptor antagonists, such as tamsulosin

  • Men with MSA often undergo surgical resection of the prostate owing to misdiagnosis as BPH; however this surgery is often ineffective owing to detrusor underactivity

Abstract

The lower urinary tract is controlled by complex neural mechanisms not only in the periphery, but also in the central nervous systems (CNS). Thus, patients with a wide variety of neurological diseases often also have lower urinary tract symptoms (LUTS), including those with Parkinson disease (PD) or multiple system atrophy (MSA). LUTS are common comorbidities associated with both of these neurodegenerative diseases and are likely to impair patients' quality of life. The motor symptoms of PD and MSA often seem similar; however, the pathophysiology, and thus the treatment of LUTS differs considerably. Antimuscarinics are the first-line treatment of storage LUTS in patients with PD or MSA; however, care should be taken in the management of these patients, especially in those with MSA owing to the high risk of inefficient voiding, and thus an increased post-void residual volume. Other treatments of PD-related LUTS include α-adrenoceptor antagonists, which improve voiding dysfunction, transurethral resection of the prostate for bladder outlet obstruction owing to prostate enlargement, and neuromodulation and intradetrusor botulinum toxin injections for storage LUTS. However, more conservative treatments, including intermittent catheterization, are required for LUTS in patients with MSA, owing to the high incidence of impaired detrusor contractility and detrusor–sphincter dyssynergia.

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Figure 1: Neural circuitry relevant to micturition in Parkinson disease (PD) or multiple system atrophy (MSA).
Figure 2: Management of lower urinary tract symptoms (LUTS) in patients with Parkinson disease (PD), multiple system atrophy (MSA) and related disorders.

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Acknowledgements

N.Y. gratefully acknowledges research support from the US National Institutes of Health (DK088836 and P01DK093424) and the US Department of Defense (W81XWH-12-1-0565).

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  1. Department of Urology, Shinshu University, School of Medicine, Matsumoto, 390–8621, Japan

    Teruyuki Ogawa & Osamu Ishizuka

  2. Department of Urology, University of Pittsburgh School of Medicine, Suite 700 Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania, USA

    Teruyuki Ogawa, Takeya Kitta & Naoki Yoshimura

  3. Department of Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, 285–8741, Japan

    Ryuji Sakakibara

  4. Neuroscience Institute, National Center of Neurology and Psychiatry, Kodaira, 187–8551, Japan

    Sadako Kuno

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R.S. and N.Y. researched data for this article. All authors made a substantial contribution to discussions of content. T.O., R.S., and N.Y. wrote the manuscript and T.K. and O.I. edited and/or reviewed the manuscript before submission.

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Ogawa, T., Sakakibara, R., Kuno, S. et al. Prevalence and treatment of LUTS in patients with Parkinson disease or multiple system atrophy. Nat Rev Urol 14, 79–89 (2017). https://doi.org/10.1038/nrurol.2016.254

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