Assessment of voiding difficulties in men with idiopathic Parkinson ’s disease

Abstract

Purpose:: Distinction between the impact of Parkinson’s disease (PD) or age-related lower urinary tract disorders such as benign prostatic hyperplasia (BPH) can be difficult in patients reporting voiding difficulties (VD). This study aimed to describe the causes of VD in men with PD, and to compare clinical and urodynamic parameters according to the mechanism. Materials and Methods:: This retrospective study included men with PD reporting VD, for whom pressure-flow studies were performed. Findings of urodynamics, voiding cystourethrogram (VCUG), and prostatic weight were collected. BPH was defined as a prostatic weight >30 cc. Urodynamic obstruction and underactivity were defined using the Bladder Outlet Obstruction Index >40 and the Bladder Contractility Index <100 respectively. Results:: Forty-one patients were included (median age 70 (IQR: 66-74)). Twenty-nine (71%) had bladder obstruction. The maximum flow rate was lower (6.8 ± 2.6 ml/s vs 13.6 ± 2.3 ml/s; p<0.001) and the post-void residual was higher in the obstructed group (99 ± 133 ml vs 9 ± 16 ml; p = 0.002). Ten patients (24%) had detrusor underactivity.Among patients with obstruction, eighteen (62%) had BPH and seven (24%) did not. Eleven obstructed patients underwent a VCUG: only one patient among the seven with BPH presented incomplete bladder neck opening compared to six among the seven patients without BPH (p = 0.02). Conclusion:: VD in patients with PD is more frequently related to bladder outlet obstruction. BPH is the primary cause, but tight bladder neck and detrusor underactivity, probably secondary to PD, must be considered. Thus, a detailed assessment of urinary disorders in this population is crucial.

Keywords

• Parkinson disease
• Lower urinary tract symptoms
• Prostatic hyperplasia
• Urodynamics