Questionnaire-based assessment of pelvic organ dysfunction in Parkinson's disease
Introduction
Various pelvic organ functions are controlled by extrinsic nervous pathways that involve neurons in the brain, spinal cord and peripheral ganglia (de Groat and Steers, 1988), of which the urinary bladder, bowel and genital organs are most commonly affected in neurological diseases. Symptoms commonly complained of by patients with idiopathic Parkinson's disease (PD) include urinary incontinence (37–70%), constipation (29–67%), and erectile dysfunction (40–60%) indicative that the central dopaminergic system is involved both in motor and autonomic pelvic functions Andersen, 1985, Berger et al., 1987, Edwards et al., 1991, Hattori et al., 1992, Gray et al., 1995, Martignoni et al., 1995, Stocchi et al., 1997, Stocchi et al., 2000. Most of these estimates are based on data from patients with PD who, because of their symptoms, visited a urology or gastroenterology clinic. In such cases, the patient samplings obviously were biased. Moreover, such symptoms are found in the general population although not much detailed information is available on each type of function Johannes and Avis, 1997, Malmsten et al., 1997, Holtedahl and Hunskaar, 1998, Laumann et al., 1999. We therefore devised a questionnaire on the three pelvic organ functions in PD patients seen at our neurology clinic and in control subjects, to establish a distinguishing hallmark between the two groups.
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Materials and methods
We recruited 115 consecutive patients with PD seen at our neurology clinic. All met the clinical diagnostic criteria of idiopathic PD (Wenning et al., 2000) and responded well to levodopa with/without dopaminergic agonists (with bromocriptine mesilate, 32; with pergolide mesilate, 32; and levodopa/carbidopa alone, 51). All the patients underwent brain magnetic resonance imaging (MRI), which showed no abnormality indicative of degenerative parkinsonism including multiple system atrophy (Beck et
Results
The completion rate of the bladder and bowel parts of the questionnaire was 100% for both the PD patients and control subjects, men and women; whereas, in the sexual part, for men it was 95% (control subjects) and 88% (PD patients) and for women 82% (control subjects) and 60% (PD patients). There was no difference in age as to the completion rate of the sexual part of the questionnaire. We analyzed sexual function for an 84-patient (46 men, 38 women) and a 356-control subject (258 men, 98
Discussion
Although pelvic organ dysfunction is recognized in idiopathic Parkinson's disease (PD), it is difficult to determine to what extent PD contributes to it. Both PD patients and men aged 60 or older may have an obstructive component that contributes to their urinary symptoms and is brought about by benign prostate hyperplasia Araki and Kuno, 2000, Lemack et al., 2000. Women may suffer urinary incontinence owing to physical stress Sandvik et al., 1993, Holtedahl and Hunskaar, 1998. Similarly,
Conclusion
Dysfunction of the bladder and bowel and of sexual performance are all prominent in patients with PD. Amelioration of pelvic organ dysfunction, particularly bowel dysfunction which most affects the quality of life, therefore, should be a primary target in the treatment of patients with PD.
Acknowledgments
We thank Drs. Toshio Fukutake, Kimihito Arai, Masato Asahina and our other colleagues at the Neurology Outpatient Clinic in Chiba University Hospital who conducted the questionnaire. We also thank Ms. Junko Taniguchi for the creation of the database.
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