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01-12-2021 | Neurogenic Bladder | Research article

Evaluation of neurogenic bladder outlet obstruction mimicking sphincter bradykinesia in male patients with Parkinson’s disease

Authors: Tianying Xing, Jinghong Ma, Tongwen Ou

Published in: BMC Neurology | Issue 1/2021

Abstract

Background

Lower urinary tract symptoms are one of the most common groups of non-movement symptoms in patients with Parkinson’s disease (PD). Storage symptoms are well-acknowledged, but neurogenic voiding dysfunction caused by PD remains a knowledge gap. This study aimed to evaluate the neurogenic bladder outlet obstruction in male patients with PD and its clinical significance.

Methods

Male patients who were diagnosed with PD and underwent urodynamic studies were retrospectively reviewed. The patients with prostate size < 30 ml and bladder outlet obstruction index ≥40 were included in the study. Lower urinary tract symptoms were evaluated by International Prostate Symptom Score (IPSS). Free flowmetry was performed and post void residual (PVR) volume was measured by ultrasound at follow-up.

Results

Six patients were included in the final analysis. The mean age was 68.2 and the mean movement symptom duration was 70.7 months. The patients had a mean IPSS of 12.5 and mean PVR volume of 70.8 ml. All patients had slow stream but none of them reported significant voiding difficulty. Urodynamic studies showed the delayed urinary sphincter relaxation and the special trace pattern. After a mean follow-up of 20 months, they had a mean IPSS of 12.5 and mean PVR volume of 73.3 ml. None of them complained of significant voiding difficulty at follow-up.

Conclusion

The delayed urinary sphincter relaxation is a rare but repeatable phenomenon in male patients with PD. It is unlikely to cause disturbing voiding dysfunction, as reported by the patients, and does not progress prominently during the course of PD. Further studies are needed to investigate the nature of this special type of neurogenic BOO and whether it is peculiar to PD in a larger patient cohort.

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Schapira AHV, Chaudhuri KR, Jenner P. Non-motor features of Parkinson disease. Nat Rev Neurosci. 2017;18(7):435–50. https://doi.org/10.1038/nrn.2017.62.CrossRefPubMed

McDonald C, Winge K, Burn DJ. Lower urinary tract symptoms in Parkinson's disease: prevalence, aetiology and management. Parkinsonism Relat Disord. 2017;35:8–16. https://doi.org/10.1016/j.parkreldis.2016.10.024.CrossRefPubMed

Winge K, Fowler CJ. Bladder dysfunction in parkinsonism: mechanisms, prevalence, symptoms, and management. Mov Disord. 2006;21(6):737–45. https://doi.org/10.1002/mds.20867.CrossRefPubMed

Ogawa T, Sakakibara R, Kuno S, Ishizuka O, Kitta T, Yoshimura N. Prevalence and treatment of LUTS in patients with Parkinson disease or multiple system atrophy. Nat Rev Urol. 2017;14(2):79–89. https://doi.org/10.1038/nrurol.2016.254.CrossRefPubMed

Yamamoto T, Asahina M, Yamanaka Y, Uchiyama T, Hirano S, Fuse M, Koga Y, Sakakibara R, Kuwabara S. Postvoid residual predicts the diagnosis of multiple system atrophy in Parkinsonian syndrome. J Neurol Sci. 15 2017;381:230–4. https://doi.org/10.1016/j.jns.2017.08.3262.CrossRefPubMed

Yeo L, Singh R, Gundeti M, Barua JM, Masood J. Urinary tract dysfunction in Parkinson's disease: a review. Int Urol Nephrol. 2012;44(2):415–24. https://doi.org/10.1007/s11255-011-9969-y.CrossRefPubMed

Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, Deuschl G. MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord. 2015;30(12):1591–601. https://doi.org/10.1002/mds.26424.CrossRefPubMed

Pavlakis AJ, Siroky MB, Goldstein I, Krane RJ. Neurourologic findings in Parkinson's disease. J Urol Jan. 1983;129(1):80–3. https://doi.org/10.1016/s0022-5347(17)51929-1.CrossRef

Godmer M, Guinet-Lacoste A, Charvier K, et al. [Is there any obstruction other than prostatic obstruction in Idiopathic Parkinson's Disease?]. Prog Urol. 2019;29(11):579–585. Existe-t-il une obstruction autre que prostatique dans la Maladie de Parkinson Idiopathique ? doi:https://doi.org/10.1016/j.purol.2019.06.001

10.

Uchiyama T, Sakakibara R, Hattori T, Yamanishi T. Short-term effect of a single levodopa dose on micturition disturbance in Parkinson's disease patients with the wearing-off phenomenon. Mov Disord. 2003;18(5):573–8. https://doi.org/10.1002/mds.10403.CrossRefPubMed

11.

Ogawa T, Seki S, Masuda H, Igawa Y, Nishizawa O, Kuno S, Chancellor MB, de Groat WC, Yoshimura N. Dopaminergic mechanisms controlling urethral function in rats. Neurourol Urodyn. 2006;25(5):480–9. https://doi.org/10.1002/nau.20260.CrossRefPubMed

12.

Yamanishi T, Yasuda K, Sakakibara R, Hattori T, Tojo M, Ito H. The nature of detrusor bladder neck dyssynergia in non-neurogenic bladder dysfunction. J Auton Nerv Syst. 1997;66(3):163–8. https://doi.org/10.1016/s0165-1838(97)00078-7.CrossRefPubMed

13.

Sakakibara R, Uchiyama T, Tamura N, Kuwabara S, Asahina M, Hattori T. Urinary retention and sympathetic sphincter obstruction in axonal Guillain-Barré syndrome. Muscle Nerve. 2007;35(1):111–5. https://doi.org/10.1002/mus.20639.CrossRefPubMed

14.

Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453–66. https://doi.org/10.1038/nrn2401.CrossRefPubMedPubMedCentral

15.

Keller JA, Chen J, Simpson S, Wang EHJ, Lilascharoen V, George O, Lim BK, Stowers L. Voluntary urination control by brainstem neurons that relax the urethral sphincter. Nat Neurosci. 2018;21(9):1229–38. https://doi.org/10.1038/s41593-018-0204-3.CrossRefPubMedPubMedCentral

16.

Sakakibara R, Hattori T, Uchiyama T, Yamanishi T. Videourodynamic and sphincter motor unit potential analyses in Parkinson's disease and multiple system atrophy. J Neurol Neurosurg Psychiatry. 2001;71(5):600–6. https://doi.org/10.1136/jnnp.71.5.600.CrossRefPubMedPubMedCentral

17.

Krhut J, Zachoval R, Rosier P, Shelly B, Zvara P. ICS educational module: electromyography in the assessment and therapy of lower urinary tract dysfunction in adults. Neurourol Urodyn. 2018;37(1):27–32. https://doi.org/10.1002/nau.23278.CrossRefPubMed

Title: Evaluation of neurogenic bladder outlet obstruction mimicking sphincter bradykinesia in male patients with Parkinson’s disease
Authors: Tianying Xing
Jinghong Ma
Tongwen Ou
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Neurogenic Bladder
Parkinson's Disease
Voiding Disorder
Published in: BMC Neurology / Issue 1/2021
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-021-02153-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of neurogenic bladder outlet obstruction mimicking sphincter bradykinesia in male patients with Parkinson’s disease

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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