Batla Amit, Tayim Natalie, Pakzad Mahreen, Panicker Jalesh N
UCL Institute of Neurology, Queen Square, 7 Queen Square, London, WC1N 3BG, UK.
Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
Curr Treat Options Neurol. 2016 Oct;18(10):45. doi: 10.1007/s11940-016-0427-0.
Urogenital dysfunction is commonly reported in Parkinson's disease (PD), and history taking and a bladder diary form the cornerstone of evaluation. The assessment of lower urinary tract (LUT) symptoms include urinalysis, ultrasonography, and urodynamic studies and help to evaluate concomitant urological pathologies such as benign prostate enlargement. Antimuscarinic medications are the first line treatment for overactive bladder (OAB) symptoms and solifenacin has been specifically studied in PD. Antimuscarininc drugs may exacerbate PD-related constipation and xerostomia, and caution is advised when using these medications in individuals where cognitive impairment is suspected. Desmopressin is effective for the management of nocturnal polyuria which has been reported to be common in PD. Intradetrusor injections of botulinum toxin have been shown to be effective for detrusor overactivity, however, are associated with the risk of urinary retention. Neuromodulation is a promising, minimally invasive treatment for PD-related OAB symptoms. Erectile dysfunction is commonly reported and first line treatments include phosphodiesterase-5 inhibitors. A patient-tailored approach is required for the optimal management of urogenital dysfunction in PD.
帕金森病（PD）患者常出现泌尿生殖功能障碍，病史采集和膀胱日记是评估的基石。下尿路（LUT）症状的评估包括尿液分析、超声检查和尿动力学研究，有助于评估诸如良性前列腺增生等伴随的泌尿系统疾病。抗胆碱能药物是治疗膀胱过度活动症（OAB）症状的一线药物，索利那新已在PD患者中进行了专门研究。抗胆碱能药物可能会加重与PD相关的便秘和口干，在怀疑有认知障碍的个体中使用这些药物时建议谨慎。去氨加压素对治疗夜间多尿有效，夜间多尿在PD患者中很常见。膀胱内注射肉毒杆菌毒素已被证明对逼尿肌过度活动有效，然而，存在尿潴留风险。神经调节是一种有前景的、微创治疗PD相关OAB症状的方法。勃起功能障碍也很常见，一线治疗包括磷酸二酯酶-5抑制剂。对于PD患者泌尿生殖功能障碍的最佳管理，需要采用个体化的治疗方法。
