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Clinical features in Parkinson’s disease: characterization of urinary symptoms according to Parkinson disease subtype

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Marilena Gubbiotti at Azienda Unità Sanitaria Locale 8 Arezzo
Marilena Gubbiotti
Francesco Ditonno at Azienda Ospedaliera Universitaria Integrata Verona
Francesco Ditonno
Elona Brahimi
Elona Brahimi
Elona Brahimi
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Stefano Rosadi
Stefano Rosadi
Stefano Rosadi
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Abstract

Purpose To evaluate whether lower urinary tract symptoms (LUTS) differ among clinical subtypes of PD and the association between urinary disorders and motor and non-motor features, quality of life (QoL), and disease variables. Methods Subjects underwent to the unified Parkinson’s disease rating scale (UPDRS) motor section part III, Hoehn–Yahr (H&Y) scale and mini-mental state examination (MMSE) to evaluate motor symptoms, the stage of disease severity, and cognitive function, respectively. Patients were divided into tremor-dominant type (TDT), akinetic-rigid type (ART), and mixed type (MXT) PD subgroups. Urinary symptoms were evaluated with 3-day voiding diary, uroflowmetry, and the incontinence quality of life questionnaires (I-QoL); psychological status by Hamilton anxiety scale (HAM-A) and Hamilton depression scale (HAM-D). Results 52 patients were enrolled; mean (± SD) age: 66.5 ± 9.6 yrs. All patients complained about at least one LUTS: 92% had urgency, 83% had increased urinary frequency, and 77% had nocturia. Disease duration was positively related to an increase in urinary frequency (p = 0.06), nocturia (p = 0.03), and negatively related to Qmax (p = 0.01). The rate of urinary frequency increased with the increase of HAM-D score (p < 0.001). The number of nocturia episodes was expression of more severe disease, as expressed by UPDRS (p < 0.001) and worse scores in HAM-A (p = 0.01) and HAM-D scores (p = 0.04). A correlation was observed between urinary frequency and HAM-A scores (p = 0.01). No significant different was observed between the clinical subtypes. Conclusion Our results suggest that LUTS correlate with the severity of motor and non- motor impairment, demonstrating also that LUTS occurrence was irrespective to PD clinical features.
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Vol.:(0123456789)
International Urology and Nephrology
https://doi.org/10.1007/s11255-025-04435-z
UROLOGY – ORIGINAL PAPER
Clinical features inParkinson’s disease: characterization ofurinary
symptoms according toParkinson disease subtype
MarilenaGubbiotti1 · FrancescoDitonno2· ElonaBrahimi3· StefanoRosadi1· EmanueleRubilotta2
Received: 31 December 2024 / Accepted: 21 February 2025
© The Author(s), under exclusive licence to Springer Nature B.V. 2025
Abstract
Purpose To evaluate whether lower urinary tract symptoms (LUTS) differ among clinical subtypes of PD and the association
between urinary disorders and motor and non-motor features, quality of life (QoL), and disease variables.
Methods Subjects underwent to the unified Parkinson’s disease rating scale (UPDRS) motor section part III, Hoehn–Yahr
(H&Y) scale and mini-mental state examination (MMSE) to evaluate motor symptoms, the stage of disease severity, and
cognitive function, respectively. Patients were divided into tremor-dominant type (TDT), akinetic-rigid type (ART), and
mixed type (MXT) PD subgroups. Urinary symptoms were evaluated with 3-day voiding diary, uroflowmetry, and the
incontinence quality of life questionnaires (I-QoL); psychological status by Hamilton anxiety scale (HAM-A) and Hamilton
depression scale (HAM-D).
Results 52 patients were enrolled; mean (± SD) age: 66.5 ± 9.6 yrs. All patients complained about at least one LUTS: 92%
had urgency, 83% had increased urinary frequency, and 77% had nocturia. Disease duration was positively related to an
increase in urinary frequency (p = 0.06), nocturia (p = 0.03), and negatively related to Qmax (p = 0.01). The rate of urinary
frequency increased with the increase of HAM-D score (p < 0.001). The number of nocturia episodes was expression of more
severe disease, as expressed by UPDRS (p < 0.001) and worse scores in HAM-A (p = 0.01) and HAM-D scores (p = 0.04).
A correlation was observed between urinary frequency and HAM-A scores (p = 0.01). No significant different was observed
between the clinical subtypes.
Conclusion Our results suggest that LUTS correlate with the severity of motor and non- motor impairment, demonstrating
also that LUTS occurrence was irrespective to PD clinical features.
Keywords Parkinson’s disease· Urinary symptoms· Clinical features· Urinary incontinence· Autonomic disorders
Introduction
Parkinson’s disease (PD) is the second most common degen-
erative neurological disorder, after Alzheimer’s disease,
resulting from the degeneration of dopaminergic neurons in
different areas of the brain [1, 2] Indeed, the pathophysiol-
ogy extends beyond dopamine decrease, but the involvement
of other neurotransmitter and neuronal pathways is not fully
understood [3].
PD has a chronic multifaceted nature and is clinically het-
erogeneous, characteristic that it shares with other neurodegen-
erative pathologies. Many studies have established subtypes
of PD based on clinical features but the most commonly used
definition is the empirical one, based on clinical observation
[4]. Empirical subtyping systems include the division of PD
into categories based on age of onset, major motor phenotypes,
and patterns of cognitive impairment, grouping PD subjects
* Marilena Gubbiotti
marilena.gubbiotti@gmail.com
Francesco Ditonno
francesco.ditonno@icloud.com
Elona Brahimi
elona.k.brahimi@gmail.com
Stefano Rosadi
stefano.rosadi@uslsudest.toscana.it
Emanuele Rubilotta
emanuele.rubilotta@aovr.veneto.it
1 Department ofUrology, Santa Maria la Gruccia Hospital,
Via del Volontariato, Montevarchi(Arezzo), Italy
2 Department ofUrology, A.O.U.I. Verona University, Verona,
Italy
3 Department ofNeurology, Regina Montis Regalis Hospital,
Cuneo, Italy
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
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