Prevalence and treatment of LUTS in patients with Parkinson disease or multiple system atrophy

Key Points Patients with Parkinson disease or multiple system atrophy (MSA) often have lower urinary tract symptoms such as urinary frequency and urinary incontinence Antimuscarinic drugs are often used in patients with storage symptoms; however, these drugs might have adverse effects such as constipation, dry mouth and cognitive deterioration Voiding difficulties owing to functional and/or mechanical outlet obstruction are also observed in both groups of patients Conservative therapies for those with voiding dysfunctions include the administration of α-adrenoceptor antagonists, such as tamsulosin Men with MSA often undergo surgical resection of the prostate owing to misdiagnosis as BPH; however this surgery is often ineffective owing to detrusor underactivity Lower urinary tract symptoms (LUTS) are common comorbidities in patients with Parkinson disease, or multiple system atrophy, and these can have considerable negative effects on patients' quality of life. In this Review, the authors describe the prevalence, diagnosis and management of LUTS in patients with PD or MSA, including the key differences in LUTS between patients with these disorders, which can, in some patients, enable a differential diagnosis. The lower urinary tract is controlled by complex neural mechanisms not only in the periphery, but also in the central nervous systems (CNS). Thus, patients with a wide variety of neurological diseases often also have lower urinary tract symptoms (LUTS), including those with Parkinson disease (PD) or multiple system atrophy (MSA). LUTS are common comorbidities associated with both of these neurodegenerative diseases and are likely to impair patients' quality of life. The motor symptoms of PD and MSA often seem similar; however, the pathophysiology, and thus the treatment of LUTS differs considerably. Antimuscarinics are the first-line treatment of storage LUTS in patients with PD or MSA; however, care should be taken in the management of these patients, especially in those with MSA owing to the high risk of inefficient voiding, and thus an increased post-void residual volume. Other treatments of PD-related LUTS include α-adrenoceptor antagonists, which improve voiding dysfunction, transurethral resection of the prostate for bladder outlet obstruction owing to prostate enlargement, and neuromodulation and intradetrusor botulinum toxin injections for storage LUTS. However, more conservative treatments, including intermittent catheterization, are required