PARKINSON’S DISEASE AND THE BLADDER The cause and nature of bladder symptoms in patients with genuine Parkinson’s disease

The cause and nature of bladder symptoms in patients with genuine Parkinson’s disease (PD) may be difficult to establish and treatment is often unsatisfactory. Typically patients present with longstanding neurological disease, the bladder symptoms coming on some years after treatment for PD was started. A recent study has shown that the severity of urinary symptoms is related to the neurological disabili t y, not the duration of the disease or the pat i e n t ’s age (1). Typically patients complain of u rgency and frequency which may be severe, and urge incontinence, particularly if poor mobility compounds their bladder disorder (2). Many male patients with PD will be in the age group in which bladder outflow obstruction due to benign prostatic hyperplasia (BPH) is a common co-existent disorder. Those with outflow obstruction complain of voiding symptoms such as hesitancy and a poor flow and furthermore may also have urgency since obstruction itself can cause detrusor overactivity. It is likely that a number of the earlier studies on PD and the bladder included patients with multiple system atrophy (MSA) and the reputation that patients with PD have a poor outcome following prostatic surgery may be due to the inadvertent inclusion of some men with MSA in the surveys. Urological intervention is not contraindicated in men with PD but it is reasonable to try these patients on anticholinergic