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A 74-year-old man with a 10-year history of progressing Parkinsonism is now starting to develop urinary symptoms in the form of poor flow, incomplete bladder emptying, frequency and urgency.
1 A deficiency of which neurotransmitter within the substantia nigra causes the features of Parkinson’s disease (PD)?
Dopamine. Parkinson’s disease is a degenerative disorder of the central nervous system of unknown aetiology. There is cell death of the dopamine-producing cells within the substantia nigra of the midbrain. This causes the clinical features of PD.
2 What is the most common long-term expression of urological dysfunction with PD?
Detrusor overactivity is the most common long-term expression of lower urinary tract dysfunction in those with PD.
3 What lifestyle changes can a patient make to help with detrusor overactivity?
To help with detrusor overactivity patients can make a number of lifestyle changes: weight loss, stopping smoking, avoiding caffeine, bladder training and pelvic floor exercises. Education is key to lifestyle changes but it does require patient motivation and can take up to 8 weeks before there are any significant results.
This patient sees a neurology specialist and has been diagnosed with multiple system atrophy (MSA). He continues to experience lower urinary tract symptoms and after doing some research online attends clinic requesting a transurethral resection of the prostate (TURP).
4 What would you advise?
You would advise not to have a TURP in the first instance. Urodynamic testing is the best way to confirm what is causing his symptoms. It is thought that the loss of neurological cells causes a loss of the inhibitory effect of the basal ganglia on the micturition reflex arc. This leads to detrusor overactivity. It is likely that this is causing his symptoms and a TURP may not help but could make his symptoms worse or even cause incontinence.