Pathophysiology and management of lower urinary tract dysfunction in parkinsonian Disorders: Update from the Neuro-Urology Promotion Committee of the ICS

Parkinson's disease and other Parkinsonian disorders, including multiple system atrophy, dementia with Lewy Bodies, progressive supranuclear palsy, and corticobasal degeneration, are commonly associated with lower urinary tract symptoms, which contribute to morbidity and reduced quality of life. The Neuro-urology Promotion Committee of the International Continence Society provides an update in the form of a scoping review, which includes literature since 2014. We focus on the pathophysiology of urinary dysfunction in the Parkinsonian disorders, as well as current and emerging treatment regimens. Data supporting the use of beta-3-agonists as well as botulinum toxin in the population with Parkinsonian disorders have accumulated rapidly, and support the safety and efficacy of these modalities in the population. Growing evidence suggests that deep brain stimulation (DBS), which is used primarily for motor symptoms, may have therapeutic potential for lower urinary tract dysfunction. However, further studies regarding patient selection and brain target selection for such therapy along with clinical trials to assess efficacy of DBS for lower urinary tract dysfunction in the Parkinsonian disorders are warranted. Over the past decade, there has been meaningful progress in the understanding of lower urinary tract symptoms in Parkinsonian disorders. Further investigation and clinical trials are essential to further refine therapeutic strategies and improve quality of life for affected individuals.