1. Nat. Rev. Urol. doi:10.1038/nrurol.2016.254
Figure 2 Management of lower urinary tract symptoms (LUTS) in patients with Parkinson disease (PD), multiple system atrophy (MSA) and related disorders
Figure 2 | Management of lower urinary tract symptoms (LUTS) in patients with Parkinson disease (PD), multiple system atrophy (MSA) and related disorders. Most bladder disorders in patients with PD are caused by PD itself, although the possibility of other common diseases should be investigated. Treatments and reassessments are required following urological cancer, stone disease and/or UTI. Nocturnal polyuria is also observed in some of these patients. Behavioural therapies, including dietary interventions and adjustments of fluid intake should be initiated in these patients. Antidiuretics are also appropriate in patients with no history of cardiac failure. The effects of medication intended to address motor symptoms on storage LUTS should then be assessed. If the LUTS are ameliorated, then the antiparkinsonian drugs should be considered to have had a beneficial effect. However, antiparkinsonian drugs might not mediate any notable changes in LUTS. Bladder outlet obstruction (BOO) can be determined using pressure–flow urodynamics. Based on a finding of overactive bladder (OAB) symptoms and a post-void residual (PVR) volume >100 ml, patients with MSA and LUTS can be divided into groups (OAB without PVR; large PVR without OAB or OAB with a large PVR). Antimuscarinic drugs should be prescribed for patients with OAB without a PVR, although care should be taken regarding the potential for an increase in PVR volume. If storage LUTS, owing to detrusor overactivity, persist, intradetrusor botulinum toxin injections or tibial nerve stimulation (TNS) can be performed. If patients have a large PVR volume (>100 ml), clean-intermittent catheterization, by patients or caregivers, should be introduced. Then, in patients in the large PVR without OAB group, α-adrenoceptor antagonists and/or cholinomimetic drugs (muscarinic receptor agonists or cholinesterase inhibitors) can be used. In the group of patients with OAB and a large PVR volume, antimuscarinic and α-adrenoceptor antagonists are used to improve OAB and PVR, respectively, although antimuscarinic agents might lead to an increase in PVR volume. Care should also be taken to avoid possible worsening of orthostatic hypotension when α-adrenoceptor antagonists are administered. If clean-intermittent catheterization cannot be performed by patients or caregivers, indwelling catheters should be considered for the control of a large PVR volume. *Indicates the optional use of cystometery, pressure–flow studies and/or videourodynamic studies for evaluation.
Ogawa, T. et al. (2016) Prevalence and treatment of LUTS in patients with Parkinson disease or multiple system atrophy
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