Effects of Dopaminergic Treatment on Bladder Function in Parkinson's Disease

Aims: To evaluate the nature of voiding complaints, findings on urodynamics and the effects of medication on bladder control in a group of Parkinson's disease (PD) patients between the ages of 30-60 years.

Methods: Thirty-two patients with PD were evaluated by questionnaires, PD rating scales, and full urodynamics evaluation. To evaluate lower urinary tract symptoms (LUTS), we used the Danish Prostate Symptom Score (Dan-PSS). PD was evaluated using Unified Parkinson's Disease Rating Scale (UPDRS), and Hoehn and Yahr rating scale for PD. Urodynamics were performed while the patients were on dopaminergic therapy, and after stopping this for three half lives.

Results: There was a significant correlation between the Dan-PSS score and UPDRS, Spearman's rho = 0.50, (P = 0.004), and between the score of irritative symptoms in Dan-PSS and motor symptoms (UPDRS(III)) is seen (Spearman's rho = 0.50, P = 0.003). Patients with significant bladder symptoms (> or =10 points in Dan-PSS) had a significantly higher bladder capacity in the medicated state than after wash out (P = 0.04), while patients with out bladder symptoms had no difference. Patients with a significant increase in bladder capacity on medication had a significantly higher interval between the volume of first sensation of bladder filling and bladder capacity when medicated (P = 0.01) than after wash out. Patient who did not benefit from medication had a significant lower interval off medication (P = 0.008).

Conclusions: The effects of dopaminergic treatment on bladder control and urodynamic parameters are unpredictable in the individual patient, though most patients experience significant changes. We have also demonstrated the complexity of bladder control, and that patients with PD may be particularly susceptible to develop complex micturitional dysfunction. Our data indicates that cortical dysfunction may play a significant role in bladder dysfunction in PD parallel to the pontine lesion.