Urological Dysfunction in Synucleinopathies: Epidemiology, Pathophysiology and Management

Overview

Journal Clin Auton Res

Date 2017 Nov 11

PMID 29124503

Citations 25

Authors

Ryuji Sakakibara

Fuyuki Tateno

Tatsuya Yamamoto

Tomoyuki Uchiyama

Tomonori Yamanishi

Affiliations

Soon will be listed here.

Abstract

Objective: Parkinson's disease (PD) and multiple system atrophy (MSA) are major neurogenerative diseases characterized pathologically by abnormal alpha-synuclein aggregation. PD and MSA are clinically characterized by motor disorder and bladder dysfunction (mainly urinary urgency and frequency, also called overactive bladder). However, few literatures are available concerning bladder dysfunction in PD or MSA.

Method: A systematic review.

Results: The bladder dysfunction in MSA is more severe than that in PD for large post-void residual or urinary retention. These bladder dysfunctions presumably reflect the different nervous system pathologies. Overactive bladder in PD reflects lesions in the brain, e.g., in the prefrontal-nigrostriatal D1 dopaminergic bladder-inhibitory pathway. Overactive bladder in MSA reflects lesions similar to PD and the cerebellum (bladder-inhibitory), and the urinary retention in MSA presumably reflects lesions in the pontine micturition center and the sacral intermediolateral nucleus of the spinal cord (bladder-facilitatory). Bladder dysfunction not only impairs an individual's quality of life, it can also cause emergency hospitalizations due to acute retention and early institutionalization. Anticholinergics are the first-line treatment for bladder dysfunction in PD and MSA patients, but care should be taken for the management of bladder dysfunction-particularly in MSA patients due to the high prevalence of difficult emptying, which needs clean, intermittent catheterization.

Conclusions: This review summarizes the epidemiology, pathophysiology, and management of bladder dysfunction in individuals with PD or MSA.

Citing Articles

A simple and effective screening strategy for early multiple system atrophy diagnosis and α-Synuclein forms in erythrocytes.

Jiang Y, Jin J, Piao Y, Yin Y, Tang L, Guan Q Front Aging Neurosci. 2025; 17:1533504.

PMID: 40061041 PMC: 11885235. DOI: 10.3389/fnagi.2025.1533504.

The examination of detrusor underactivity in multiple system atrophy.

Yamamoto T, Sakakibara R, Uchiyama T, Kuwabara S Front Neurol. 2024; 15:1460379.

PMID: 39355089 PMC: 11442385. DOI: 10.3389/fneur.2024.1460379.

Urinary continence networks in Parkinson's disease: a resting state functional MRI study.

Roy H, Roy C, Tempest H, Green A, Menke R BJU Int. 2024; 135(1):57-59.

PMID: 39192548 PMC: 11628875. DOI: 10.1111/bju.16518.

Alpha Synuclein Toxicity and Non-Motor Parkinson's.

Mazzotta G, Conte C Cells. 2024; 13(15.

PMID: 39120295 PMC: 11311369. DOI: 10.3390/cells13151265.

Non-Pharmacological Treatment of Autonomic Dysfunction in Parkinson's Disease and Other Synucleinopathies.

Palma J, Thijs R J Parkinsons Dis. 2023; 14(s1):S81-S92.

PMID: 37694308 PMC: 11380254. DOI: 10.3233/JPD-230173.

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