December 2011
Uchiyama T, Sakakibara R, Yamamoto T, Ito T,
Yamaguchi C, Awa Y, Yanagisawa M, Higuchi Y, Sato Y,
Ichikawa T, Yamanishi T, Hattori T, Kuwabara S
Background: Urinary dysfunction is common in Parkinson's disease (PD); however, little is known about urinary dysfunction in early and
untreated PD patients.
Methods:
Fifty consecutive untreated PD patients (mean age, 66.7; mean disease
duration, 23.6 months; and mean Hoehn & Yahr scale, 1.9) were
recruited; those with other conditions that might have influenced
urinary function were excluded. Patients were evaluated using a urinary
questionnaire and urodynamic studies.
Results:
Sixty-four per cent complained of urinary symptoms (storage, 64.0%;
voiding, 28.0%). Urodynamic studies showed abnormal findings
in the storage phase in 84%, with
detrusor overactivity (DO) and increased bladder sensation without DO in
58.0% and 12.0%
of patients, respectively. In the
voiding phase, detrusor underactivity, impaired urethral relaxation such
as detrusor sphincter
dyssynergia, and bladder outlet
obstruction were present in 50.0%, 8.0% and 16% of patients,
respectively. In patients with
both storage and voiding phase
abnormalities, DO+detrusor underactivity was the most common finding.
Few patients experienced
urge incontinence and/or
quality-of-life impairment owing to urinary dysfunction; none had
low-compliance bladder or abnormal
anal-sphincter motor unit potential.
These urinary symptoms and urodynamic findings were not correlated with
gender, disease
severity or motor symptom type.
Conclusion:
Urinary dysfunction, manifested primarily as storage disorders with
subclinical voiding disorders and normal anal-sphincter
electromyography, occurs in early
and untreated PD patients. In cases with severe voiding disorder and/or
abnormal anal-sphincter
electromyography, other diagnoses
should be considered.
