Ch65 Parkinson syndrome and LUTS

  1. Parkinsonism other than PD?
    • (1) Multiple system atrophy (MSA: includes striatonigral degeneration, sporadic olivopontocerebellar atrophy, and Shy-Drager syndrome);
    • (2) Progressive supranuclear palsy;
    • (3) Cortical-basal ganglionic degeneration;
    • (4) Vascular parkinsonism; and
    • (5) dementia with Lewy bodies.
  2. How to differentiate PD with parkinsonism produced by other causes?
    • The combination of asymmetry of symptoms and signs, the presence of a resting tremor, and a good response to levodopa
    • None of these is individually specific for PD.
  3. How to distinguish lower urinary tract symptoms caused by MSA from those caused by PD?
    • The following suggest MSA:
    • (1) urinary symptoms precede or present with parkinsonism;
    • (2) urinary incontinence;
    • (3) significant postvoid residual;
    • (4) initial erectile failure; and
    • (5) abnormal striated sphincter electromyogram
  4. The most common urodynamic finding in PD?
    Detrusor overactivity - basal ganglia normally have an inhibitory effect on the micturition reflex, which is abolished by the cell loss in the substantia nigra.
  5. TURP in PD?
    TURP should not be contraindicated in patients with PD because external sphincter acontractility is extremely rare.

    Voiding dysfunction secondary to PD defies “routine” classification within any system. It is most manifest by storage failure secondary to bladder overactivity, but detailed urodynamic evaluation is mandatory before any but the simplest and most reversible therapy.
  6. Urological features of MSA?
    • The initial urinary symptoms of MSA are urgency, frequency, and urgency incontinence, occurring up to 4 years before the diagnosis is made, as does erectile failure.
    • Detrusor overactivity is frequently found, as one would expect from the central nervous system areas affected, but decreased compliance may occur, reflecting distal spinal involvement of the locations of the cell bodies of autonomic neurons innervating the lower urinary tract.
    • As the disease progresses, difficulty in initiating and maintaining voiding may occur, probably from pontine and sacral cord lesions, and this is generally associated with a poor prognosis.
  7. UDS finding of MSA?
    Cystourethrography or videourodynamic  studies may reveal an open bladder neck (intrinsic sphincter deficiency), and many patients exhibit evidence of striated sphincter denervation on motor unit electromyography.
  8. Urinary Prognosis of MSA?
    • The smooth and striated sphincter abnormalities predispose women to sphincteric incontinence and make prostatectomy hazardous in men.
    • The treatment of significant voiding dysfunction caused by MSA is difficult and seldom satisfactory
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Ch65 Parkinson syndrome and LUTS