年輕女性合併帕金森氏症及下尿路功能障礙之個案分享
蔡勝閔1、林才揚1、李高漢1、黃冠華1
台南永康奇美醫學中心 外科部 泌尿科1
Case presentation: A Young Female with Parkinson Disease and Lower Urinary Tract Dysfunction
Sheng-Min Tsai1、Chye-Yang Lim1、Kau-Han Li1、Steven K. Huang1
1Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
Introduction
Parkinson’s disease (PD) is a common neurodegenerative disorder which is characterized by degeneration of dopaminergic neurons in the substantia nigra. Parkinson disease is uncommon among individuals younger than 50 years. Lower urinary tract dysfunction (LUTD) is one of the most common autonomic disorders with an estimated incidence rate of 27–80% in the patients with Parkinson’s disease. Here, we present a case of young female patient diagnosed with secondary Parkinson disease and lower urinary tract dysfunction. Further evaluation and treatment in such patient will be discussed.
Case Presentation:
This 38 years old female patient with history of depressive disorder was found BZDs drug overdose with acute respiratory failure in 2019/7. She was ever admitted neurology ward due to dramatic decline of cognitive function. Further MRI revealed hypoxia encephalopathy with organic brain syndrome was impressed. Secondary Parkinson disease was thus diagnosed. This patient visited urology clinic in 2020/2 with complaints of urinary frequency, urge urinary incontinence and nocturia for several months. Primary survey as urine analysis, uroflowmetry, urotact echo were done. Mild urinary tract infection, thicken bladder wall and normal uroflowmetry were impressed. Medical treatment with antimuscarinics, anticholinergics and electrical stimulation were administered. However, only limited improvement was noted.
Voiding diary revealed urinary frequency and limited functional bladder capacity. The Overactive Bladder Symptom Score (OABSS) showed severe overactive bladder. We arranged video urodynamic study (VUDS) which showed poor bladder compliance, hypersensitive bladder, and detrusor overactivity. The patient received suburothelial Botox injection, and the symptoms improved and voiding interval prolonged to 4 hours.
Discussion:
LUTD is commonly seen in the patients with Parkinson’s disease. The pathogenesis is considered that decreased function in basal ganglia may lead to loss of inhibitory effect on the micturition reflex. The most common urodynamic finding is detrusor overactivity(DO). The medical treatment included drugs for storage LUTS, voiding LUTS and Parkinson’s disease. Posterior Tibial Nerve Stimulation(PTNS) has been illustrated that positive effect of suppressing detrusor overactivity in PD patients. Deep brain stimulation of the subthalamic nucleus in PD cases has benefit in not only motor symptoms but also in LUTD. Intravesical injection of Botox has been commonly applicated in OAB, neurogenic DO or non-neurogenic voiding dysfunction. This case showed a inspiring experience in treating with Botox injection in patient with LUTD in PD.