1. Bladder Dysfunction Associated With Parkinson’s Disease
Kiavash Nikkhou, MD
Urology & Urologic Oncology
Thousand Oaks, CA

4. Normal Bladder Function
Filling (storage) Phase requires:
Accommodation
Absence of involuntary bladder muscle contractions
Closed sphincter
Empting (voiding) Phase requires:
Absence of obstruction (i.e. enlarged prostate)
Open sphincter
Coordinated bladder muscle contraction

5. Voiding Reflex
Intimacy of brain and bladder for urinary control and function:
When 1-2 cups of urine have collected in the bladder, the bladder sends signal to the brain to cause bladder contraction and sphincter relaxation, thus initiating urination. However, the brain can suppress these signals until it is convenient for the person to reach the bathroom. When ready, or when bladder is overstretched, the brain allows the bladder to contract while the sphincter relaxes.

6. Parkinson’s Disease
Loss of Dopamine-producing cells in the substantia Nigra
Voiding dysfunction present in 35-70%
Typical urinary symptoms:
Frequency
Urgency
Night time urination (nocturia)
Involuntary leakage of urine (incontinence)
Weak stream
Incomplete bladder emptying

7. How can PD affect my bladder?
Most common problem is difficulty holding urine
Bladder becomes overactive and wants to contract even with small volume of urine
Symptoms: Frequency, urgency, night time urination, and urge incontinence
Treatment options which help relax bladder muscle
Evaluation by Urologist needed
Medications: Ditropan, Detrol, Vesicare, Myrbetriq
Bladder Botox®
Neuromodulators

8. OAB Treatment Algorithm
History and Physical Exam
Postvoid Residual
Behavioral Modifications
Oral Medications
i.e. Anticholinergics, B3 agonists
Bladder Botox ®
Neuromodulation
(SNS, PTNS)

9. Oral Medications for OAB
Anticholinergics:
Relax bladder by blocking signals to contract bladder
Ex: Ditropan, Detrol, Vesicare
Side effects: dry mouth, dry eyes, constipation, cognitive deficits
Beta-3 agonists:
Relax bladder by stimulating B3 receptors
Myrbetriq ®
Side effects: high blood pressure
Limitations: cost

10. Bladder Botox ®
units of Botox is injected into the bladder using a flexible cystoscope in the office.
Risks: 5% risk of retention requiring self cath or foley
Efficacy:
Can provide improvement in symptoms up to 1 year
On average readminister at 6-9 months

11. How can PD affect my bladder?
Another common problem is difficulty emptying bladder
Weak bladder muscle, or
Sphincter that closes when bladder contracts (detrusor-sphincter dyssynergia)
Symptoms: Weak stream, dribbling, leakage, feeling of incomplete emptying
Can be dangerous
Bladder infection, kidney damage
Treatment options:
Evaluation by Urologist
Intermittent catheterization, Foley, SPT

12. Workup
Urologists are often able to determine the diagnosis based on your symptoms. However, further studies may be ordered if your symptoms are:
Complex
Difficult to elicit
Persistent despite therapy
Potential workup may include:
Bladder diary
Uroflow
Postvoid residual
Urodynamic Study (UDS)

13. Uroflow Measures volume, voiding time, Peak flow rate, mean flow rate
Male ml/sec
Female ml/sec
Obstruction = < 10 ml/sec

14. Abnormal Uroflow
Obstructed Pattern
Staccato Pattern

15. Urodynamic Study
In office study to evaluate bladder behavior at various stages of filling and emptying
Study is personalized to patient’s symptoms and voiding complaints
During filling phase, the bladder is slowly filled with fluid while assessing for involuntary bladder contractions, leakage or increasing bladder pressures.
During voiding phase, bladder pressures, voluntary bladder contraction, sphincter activity, and volume voided are measured

16. UDS in OAB

17. Conclusion
Parkinson’s Disease can cause significant bladder dysfunction
Symptoms can include frequency, urgency, night time urination, weak stream, leakage
See your urologist for your symptoms and to discuss potential treatment options
THANK YOU!
Kiavash Nikkhou, MD
Urology & Urologic Oncology
415 Rolling Oaks Drive Suite 260
Thousand Oaks, CA 91361
(805)