Editing Neurogenic LUT Dysfunction (section)

=== Parkinson disease ===

* A neurodegenerative disorder of unknown cause that affects primarily the dopaminergic neurons of the substantia nigra
** Classic symptoms include tremor, skeletal rigidity, and bradykinesia
** The gold standard for the diagnosis of PD is the neuropathologic examination
* LUT dysfunction occurs in 35-70% of patients with PD
** It has been hypothesized that dopamine modulates the normal micturition reflex, and therefore neurogenic degeneration in the nigrostriatal pathway leads to the significant LUT dysfunction associated with PD
** '''When LUT dysfunction does occur:'''
*** '''Symptoms usually consist of urgency, frequency, nocturia, and urgency incontinence.'''
*** '''The most common urodynamic finding is detrusor overactivity'''
*** '''The smooth sphincter is synergic'''
*** '''Pseudodyssynergia may occur, as well as a delay in striated sphincter relaxation (bradykinesia) at the onset of voluntary micturition, both of which can be urodynamically misinterpreted as true dyssynergia'''
*** '''Impaired detrusor contractility may also occur, either in the form of low amplitude or poorly sustained contractions or a combination. Detrusor areflexia is relatively uncommon in PD.'''
** PET scanning shows brain responses with bladder filling.
** '''The time from onset of PD to initiation of LUTS is ≈5 years'''
* '''TURP should not be contraindicated in patients with PD, because external sphincter acontractility is extremely rare in such patients. However, one must be cautious with such patients, and a complete urodynamic or video-urodynamic evaluation is advisable.''' Poorly sustained bladder contractions, sometimes with slow sphincter relaxation, should make one less optimistic regarding the results of outlet reduction in the male.