The Study Of Vesicourethual Dysfunction In Parkinson's Disease

Objective:1.To discuss the prevalence and risk factors of Vesicourethual dysfunction(VUDF) in Parkinson's disease(PD)。For the prevention, early intervention and treatment provide an objective basis for implementation。2.To analyze findings on urodynamic study after Parkinson's disease PD, to Discussion on pathophysiological mechanisms and characteristics in vesicourethral dysfunction of Parkinson's disease ,and lay the foundation for the diagnosis and timely treatment。Methods:1. 209 cases of Parkinson's disease patients evaluataed retrospective study,involved between September,2005 and November,2006 from first Affiliated Hospital,Chongqing University of Medical Science in neurology outpatients and hospitalization。Patients were classified: group vesicourethual dysfunction(VUDF 47.8%)and group normal of voiding(NV 52.2%)。The study included general state, past history, the severity of the disease, course and autonomic nervous symptoms。Single analysis and multiple factors analysis were conducted by x~2 test and logistic regression respectively.2. Urodynamics were performed in 32 patients after PD, 64 males with BPH。Parkinson's patients will be divided into early stage group (H-Y <3) and advanced stage group(H-Y>3),comparison and analysis of urodynamics results among early stage group,advanced stage group and BPH。Results:1. The prevalence of patients with VUDF were 48.4%,In univariate analysis ,older,smoking,greater disabilitywere significantly associated with VUDF(P <0.05) , Highly educated patients was not easy with VUDF(P <0.05), Associated with the autonomic nervous system symptoms was correlation factor (P <0.05),Logistic multivariate analyses showed that age(OR=3.43,95%CI1.41-7.15),greater disability(Hoehn-Yahr :OR= 5.29,95%CI 1.25-9.34,Webster scores:OR=4.13,95%CI 2.02-8.81),smoking(OR=2.76,95 %CI1.33-5.46)were risk factors to the occurrence of VUDP。High culture was protective factor。The autonomic nervous system symptoms was correlation factor。2. (1)The studies in 32 PD revealed various findings, detrusor hyperreflexia was found in 22 (68.7%), hyporeflexia or areflexia in 6 (18.8%),normal function in 4(12.5%),detrusor sphincter dyssynergia in 2(6.25%), the low compliance of bladder in 11(34.4%),the volume of first bladder sensation was(81.6±25.9)ml,bladder capacity was (212.1±64.2)ml。The maximum flow rate was(10.4±6.3)ml/s ,the pressure of the detrusor at the maximal flow rate(PdetQmax) was(54.7±36.4)cmH2O ,the residual urine volume was(59.8±33.6)m1,bladder outlet obstruction in 10(31.3%)。(2) In early stage group the volume of first bladder sensation was (72.4±32.6)ml;while in advanced stage group it was(94.1±37.5)ml,and bladder capacity was(227.6±66.3)m1。The maximum flow rate was(6.1±4.5)ml / min , PdetQmax was(32.1±16.1)cm H20。The residual urine volume was(95.6±39.4)m1。(3)In 64 patients with benign prostatic hyperplasia,detrusor hyperreflexia was found in 35 (54.7%),hyporeflexia or areflexia in 10 (15.6%),normal function in 19(29.7%),detrusor sphincter dyssynergia in 0(0.00%), the low compliance of bladder in 18(28.1%),the volume of first bladder sensation was(154.2±38.5)ml,bladder capacity was (238.3±53.4)ml。The maximum flow rate was(8.6±4.3)ml/s ,the pressure of the detrusor at the maximal flow rate(PdetQmax) was(68.5±34.2)cmH2O ,the residual urine volume was(93.2±47.4)m1,bladder outlet obstruction(BOO)in 41(64.1%)。Conclusion:1. The incidence of vesicourethual dysfunction is high in Parkinson's disease,older,smoking,greater disabilitywere significantly risk factors。Associated with the autonomic nervous system symptoms was correlation factor,and drinking wine,drinking tea,hypertension, course of disease were no correlation ,High culture was protective factor。2. (1) Our results confirm that urodynamic abnormalities were high in Vesicourethual dysfunction of Parkinson's disease。At early stage group it was mainly detrusor hyperreflexi, the volume of first bladder sensation was decrease。At advanced stage group it was mainly impaired detrusor, the maximum flow rate was diminish, the residual urine volume was increase, the pressure of the detrusor at the maximal flow rate was diminish。(2) Comparsion with BPH ,No difference was found in the occurrence ofdetrusor instability,but BOO and the volume of first bladder sensation were lower。Parkinson's disease with BPH often needs to use the early medicine treatment or the surgical operation relieves the obstruction。...