Urinary symptoms in patients with Parkinson's disease and progressive supranuclear palsy: Urodynamic findings and management of bladder dysfunction

Abstract

To observe urinary symptoms in patients with Parkinson's disease (PD) and progressive supranuclear palsy (PSP) and advice bladder dysfunction management based on urodynamic study findings. Twenty-two patients (12 males) with PD and PSP (15 and 7 respectively) with urinary symptoms were included. All patients except one were on levodopa and carbidopa medication. Urodynamic study (UDS) was performed and bladder management determined. Mean age was 60.4 years (range 41–73 years, SD8.4). Mean illness duration was 31.9 months (range 9–146 months, SD31.0) and mean duration of urinary symptoms were 14.8 months (range 1–61 months, SD15.8). Eighteen patients reported nocturia and 16 patients had urgency with or without urge incontinence. Three patients had retention and straining to void and 3 had mixed urinary complaints. Twelve out of 22 patients had absence of voluntary anal contraction (VAC) on per-rectal examination. UDS was suggestive of 12 patients with neurogenic detrusor overactivity (NDO) with or without sphincter dyssynergy. Six patients had normal detrusor pressure and 4 patients were found to have acontractile detrusor. Ten patients had significant post-void residual. Bladder management included pharmacotherapy, supportive and behavioural management as appropriate. Patients with PD/PSP are known to develop urinary symptoms during the course of illness. Clinical complaints and UDS findings do not necessarily match. UDS is required to manage urinary symptoms. Most of the patients respond to oral anti-muscarinic medications along with behavioural and supportive therapy.