Objective: The aim of this paper is to present a case and its assessment and management.

Background: The bladder dysfunction is one of the most common autonomic disorders in Parkinson’s disease (PD), the estimaded incidence is 55 to 80%. The lower urinary tract symptoms are divided in two types: storage related: Nocturia > 60%, Urinary urgency, and bladder emptying related: 44% are delays in starting urination and stress urination 28%, suggesting difficulty in sphincter relaxation, also called Bradykinesia of external urethral sphincter.¹

Methods: A 61 year old male with history of DM and Hypertension, PD akinetic rigid diagnosed and treated since 2001 with dopamine agonist and levodopa, currently Hoehn and Yahr stage IV, 23 points of NMSQUEST and 80 points of UPDRS MDS, 23 points MoCa was referred to a Neuro-Urologist because 6 months of important Pollakiuria that led him to urinary incontinence for which he used diapers for 3 months, urinary retention, a Foley was placed but attempts to remove it were unsuccessful. An urodynamic study is performed finding normal filling pressures, in the perineal EMG an impossibility for relaxation impairs urination; Bradykinesia (detrusor-sphincter dyssynergia) led us to the use of Dantrolene. And the withdrawal of the Foley along with the start of clean intermittent catheterization (CIC) every 6 hrs. Initially 100% of the urine was obtained with CIC but after two weeks urination restarted in diaper currently conducting a CIC at night getting 190 mL of residual urine.

Results: Many studies have shown a relationship between increased severity of neurological disease and urinary problems.¹² SPECT studies have also shown the correlation between urinary dysfunction and nigroestriatal degeneration. A greater loss in the striatum increase urinary conditions compared with those who haven´t. A Danish study demonstrated that the severity of bladder dysfunction is correlated with a relative degeneration of the caudate nucleus compared to the putamen. However Braak’s hypothesis proposes that the degeneration starts ascending, in explaining the neurological impairment it sounds reasonable.

Conclusions: Urinary problems in Parkinson’s patients are very frequent, which is why they must be monitored in order to improve their quality of life and prevent damage to the urinary tract, providing adequate and timely attention these problems can be controlled and their symptoms can improve significantly.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/bradykinesia-of-external-urethral-sphincter-in-a-patient-with-parkinsons-disease-case-report/