Urogenital dysfunction is commonly reported in Parkinson's disease (PD), and history taking and a bladder diary form the cornerstone of evaluation. The assessment of lower urinary tract (LUT) symptoms include urinalysis, ultrasonography, and urodynamic studies and help to evaluate concomitant urological pathologies such as benign prostate enlargement. Antimuscarinic medications are the first line treatment for overactive bladder (OAB) symptoms and solifenacin has been specifically studied in PD. Antimuscarininc drugs may exacerbate PD-related constipation and xerostomia, and caution is advised when using these medications in individuals where cognitive impairment is suspected. Desmopressin is effective for the management of nocturnal polyuria which has been reported to be common in PD. Intradetrusor injections of botulinum toxin have been shown to be effective for detrusor overactivity, however, are associated with the risk of urinary retention. Neuromodulation is a promising, minimally invasive treatment for PD-related OAB symptoms. Erectile dysfunction is commonly reported and first line treatments include phosphodiesterase-5 inhibitors. A patient-tailored approach is required for the optimal management of urogenital dysfunction in PD.
Current treatment options in neurology. 2016 Oct [Epub]
Amit Batla, Natalie Tayim, Mahreen Pakzad, Jalesh N Panicker
UCL Institute of Neurology, Queen Square, 7 Queen Square, London, WC1N 3BG, UK. ., Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK., Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, UK.