Introduction and Purpose
Parkinsonism is a neurodegenerative condition of unknown etiology and it accompanies lower urinary tract symptoms.
Several studies have investigated the correlation between voiding difficulties and urodynamic findings. One previous study indicated that international prostate symptom score (IPSS) was positively correlated with the severity of Parkinsonism; the storage symptom score correlated with the maximal cystometric capacity and the volume present at the first desire to void, and the voiding symptom score was associated with the postvoid residual volume. Additionally, the voiding symptom score, PSA and transitional zone volume were identified as important risk factors for developing severe voiding difficulties in the patients with mild LUTS (IPSS<8). Othert study documented that the LUTS correlated with the severity of rigidity and the number of years with Parkinsonism. However, another reported that the duration and severity of Parkinsonism were not predictive of the characteristics or severity of the urodynamic findings. The aim of this study was to evaluate the correlation between LUTS and urodynamic findings.
Methods
A retrospective study was performed in patients with Parkinsonism presenting to the urology department with LUTS between January 2001 and July 2007. All patients were evaluated using validated questionnaires (IPSS) on LUTS. All of the patients underwent conventional fluoroscopic UDS. Approval for this study was granted by the Institutional Review Board of the Seoul National University Hospital. Descriptive analyses of urodynamic findings and clinical factors such as age, gender, and duration of Parkinsonism were expressed as the mean and standard deviation (SD). The Student t-test and ANOVA were used for the analysis of the urodynamic findings according to age, gender, the duration of Parkinsonism, and IPSS.
Results
One hundred and two subjects were included in the analysis (60 males and 42 females); 14 patients were in their fifties, 34 in their sixties, 42 in their seventies, and 8 in their eighties. The mean duration of the Parkinsonism was 6.8±3.6 (SD) years. In this study, Parkinsonism included Parkinson’s disease and multiple system atrophy in 83.3% and 16.7%, respectively. The LUTS was mild (IPSS<8) in 4.9%, moderate (8≤IPSS≤19) in 29.6% and severe (20≤IPSS) in 65.4%. Voiding difficulties included a feeling of incomplete emptying (61.8%), increased daytime frequency (61.8%), urgency (52.0%), nocturia (44.1%), a slow stream (33.3%), hesitancy (22.5%), intermittency (21.6%), urge incontinence (21.6%), and stress urinary incontinence (14.7%). The mean maximal flow rate was 11.0±7.2 ml/sec. The median postvoid residual volume was 136.8 ml (range from 0 to 301). Involuntary detrusor contraction (IDC) was found in 60.8% of patients. The pressure-flow study showed a detrusor pressure of 39.8±18.9 cmH2O at maximum flow. The nomogram showed an unobstructed pattern in 51.8% of cases was equivocal in 31.5% and obstructed in 16.7%, among males. The fluoroscopic examination revealed the presence of bladder trabeculations in 17.8%; they were mild in 7.9%, moderate in 3% and severe in 6.9%. There was no patient with vesicoureteral reflux detected by fluoroscopic monitoring. Age, gender and duration of disease showed no significant differences when the IPSS and UDS were compared. The symptom score was negatively correlated with the maximal flow rate and voided volume. By contrast, it was positively correlated with the presence of bladder trabeculations. The presence of IDC was significantly correlated with a diminished maximal flow rate and a decreased maximal cystometric capacity, and significantly correlated with an increased storage symptom score. Urodynamic examination revealed detrusor overactivity in 60.8% of patients. Detrusor underactivity and normal activity during the storage phase was found in 19.6% of cases. Detrusor overactivity and impaired contractile function was 14.7% of cases. Only 19.6% of the patients had normal findings for both the storage and voiding phases. The urodynamic evaluation showed no significant differences among the 4 groups classified according to detrusor activity during the storage and voiding phases.
Conclusions
The subjective LUTS did not predict the urodynamic findings. Therefore, individualized UDS are needed to determine the diagnosis and treatment of patients with Parkinsonism and LUTS.
Keywords
Parkinsonism, Parkinsonian syndrome, urodynamics