Blasenstörungen bei Parkinson-Syndromen

Zusammenfassung

Diese Übersicht behandelt Blasenstörungen bei Parkinson-Syndromen, ein für viele Patienten sehr beeinträchtigendes Problem. Früh im Krankheitsverlauf auftretende Blasenstörungen sind typisch für eine Multisystematrophie, einen Normaldruckhydrozephalus oder ein Parkinson-Syndrom bei subkortikaler vaskulärer Enzephalopathie. Beim idiopathischen Parkinson-Syndrom liegt die Prävalenz von Blasenstörungen bei ca. 60% und nimmt altersabhängig zu. Das am häufigsten beklagte Symptom ist der imperative Harndrang (hyperaktive Blase, engl. overactive bladder, OAB), verursacht durch eine Überaktivität des M. detrusor vesicae. Imperativer Harndrang und eine erhöhte Miktionsfrequenz führen insbesondere bei schlechter Beweglichkeit zur Dranginkontinenz. Zur Behandlung der Beschwerden werden häufig Anticholinergika eingesetzt, die wegen der unerwünschten anticholingergen Effekte wie kognitive Verschlechterung, Obstipation und Harnverhalt insbesondere bei Parkinson-Patienten problematisch sein können. Beta-3-adrenerge Agonisten stellen eine potenziell günstigere Behandlungsalternative als Anticholinergika dar. Die intravesikale Injektion von Botulinumtoxin ist für einzelne Patienten ein interessanter Ansatz, wenngleich diese Therapieoption beim M. Parkinson im Gegensatz zu anderen Ursachen neurogener Detrusorhyperaktivität (z. B. Multiple Sklerose) bisher wenig Verbreitung gefunden hat.

Summary

This review covers urinary symptoms in parkinsonism. Urinary symptoms represent an impairing problem which is often neglected. Urinary symptoms occurring early in the course of a parkinsonian syndrome are typical for multiple system atrophy, normal pressure hydrocephalus and parkinsonism associated with subcortical vascular encephalopathy. The prevalence of urinary symptoms in Parkinson’s disease is about 60% and increases with age. Caused by detrusor overactivity, overactive bladder is the most common urinary symptom in PD patients. Urge and increased frequency especially in combination with impaired mobility cause urge incontinence. In addition to a sufficient dopaminergic therapy, an add-on therapy with anticholinergics is required. Adverse effects like cognitive impairment, constipation or urinary retention need to be considered in PD patients. Beta-3 adrenergic agonists might become a potential treatment option because they show little to no cognitive side effects. Newer therapeutic approaches, such as intravesical Botulinum toxin injections, are expected to improve bladder dysfunction in PD and thus quality of life of PD patients.

Schlüsselwörter

Parkinson-Syndrom - Blasenstörungen - Anticholinergika - Mirabegron - DBS - Botulinumtoxin

Keywords

Parkinson’s disease - urinary symptoms - over-active bladder - anticholinergics - mirabegron - DBS - botulinum toxin

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