Phé V, Caremel R, Bart S, Castel-Lacanal E, de Sèze M, Duchêne F, Even A, Gamé X, Loubat M, Scheiber Nogueira M C, Karsenty G
Service d'urologie et de transplantation rénale, université Pierre-et-Marie-Curie, université Paris VI, CHU Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Prog Urol. 2013 Apr;23(5):296-308. doi: 10.1016/j.purol.2012.12.004. Epub 2013 Jan 5.
Lower urinary tract disorders (LUTD) are common in Parkinson's disease (PD) and other parkinsonian syndromes (PS). They are responsible for a significant morbidity and mortality and impair patients' quality of life. The therapeutic management of these LUTD requires to know how to distinguish the PD from other PS and their epidemiology and pathophysiology.
To provide a diagnostic and therapeutic management of LUTD in patients with PS.
A review of litterature using PubMed library was performed using the following keywords: Parkinson's disease, multiple system atrophy, lower urinary tract disorders, neurogenic bladder, overactive bladder, obstruction, anticholinergics, dopamine, prostate surgery.
Sometimes revealing the neurological disease, LUTD in PS raise a diagnostic problem because they occur at an age when various urogynecological disorders can be intricated with neurogenic bladder dysfunction. The differential diagnosis between PD and multiple system atrophy is important to know by the urologist. The distinction is based on the semiological analysis, the clinical response to dopaminergic therapy and the clinical outcome but also on data from urodynamic explorations. The therapeutic management of these LUTD cannot be easy due to the difficulty of use of some pharmacological treatments and the risk of deterioration after inappropriate surgery. The different treatments include the careful use of anticholinergics, posterior tibial nerve stimulation, deep thalamic stimulation and low-dose intradetrusor injections of botulinum toxin without approval. The decision to perform prostate surgery will be taken with caution after proving the bladder obstruction.
When analysing LUTD in PS, the urologist must know to question the initial diagnosis of PD. Treatments in order to reduce morbidity and mortality of these LUTD and to improve the quality of life of patients suffering from these degenerative diseases, will be proposed after multidisciplinary neuro-urologic concertation. The decision to perform prostate surgery must be taken with caution after proving sub-vesical obstruction.
下尿路功能障碍（LUTD）在帕金森病（PD）和其他帕金森综合征（PS）中很常见。它们会导致显著的发病率和死亡率，并损害患者的生活质量。这些LUTD的治疗管理需要了解如何将PD与其他PS区分开来，以及它们的流行病学和病理生理学。
为PS患者的LUTD提供诊断和治疗管理。
使用PubMed数据库，以以下关键词进行文献综述：帕金森病、多系统萎缩、下尿路功能障碍、神经源性膀胱、膀胱过度活动症、梗阻、抗胆碱能药物、多巴胺、前列腺手术。
PS中的LUTD有时是神经系统疾病的首发症状，会引发诊断问题，因为它们发生在各种泌尿妇科疾病可能与神经源性膀胱功能障碍相互交织的年龄。泌尿外科医生了解PD和多系统萎缩之间的鉴别诊断很重要。这种区分基于症状学分析、对多巴胺能治疗的临床反应和临床结果，也基于尿动力学检查数据。由于一些药物治疗使用困难以及不适当手术有恶化风险，这些LUTD的治疗管理并非易事。不同的治疗方法包括谨慎使用抗胆碱能药物、胫后神经刺激、丘脑深部刺激以及未经批准的低剂量膀胱逼尿肌内注射肉毒杆菌毒素。在证实膀胱梗阻后，才会谨慎决定是否进行前列腺手术。
在分析PS中的LUTD时，泌尿外科医生必须知道质疑PD的初始诊断。在多学科神经泌尿会诊后，将提出旨在降低这些LUTD的发病率和死亡率并改善患有这些退行性疾病患者生活质量的治疗方法。在证实膀胱下梗阻后，必须谨慎决定是否进行前列腺手术。
