Neurourology and Urodynamics 28:510–515 (2009) Voiding Dysfunction in Patients With Parkinson’s Disease: Impact of Neurological Impairment and Clinical Parameters Zein M. Sammour, 1 Cristiano M. Gomes, 1 Egberto R. Barbosa, 2 Roberto I. Lopes, 1 Fla ´vio S. Sallem, 2 Flavio E. Trigo-Rocha, 1 Homero Bruschini, 1 Miguel Srougi 1 1 Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil 2 Department of Neurology, University of Sao Paulo School of Medicine, Sao Paulo Brazil Aims: We assessed the lower urinary tract symptoms (LUTS) of patients with Parkinson’s disease (PD) and their association with different clinical parameters. Methods: We prospectively evaluated 110 patients (84 men), with a mean age of 61.8  9.6 years. Mean duration of the disease was 12.3  7.2 years. Neurological impairment was assessed by the Hoehn–Yahr and the Unified Parkinson Disease Rating scales. LUTS were assessed by the International Continence Society questionnaire. We evaluated the impact of age, PD duration, neurological impairment, gender, and use of anti-Parkinsonian drugs on the voiding function. Results: On multivariate analysis, voiding dysfunction increased with the neurological impairment, but not with patient’s age or disease duration. Quality of life (QOL) was affected by the severity of LUTS, and the symptoms with the worst impact were frequency and nocturia. Sixty-three (57.2%) patients were symptomatic. They did not differ with the asymptomatic as to age and disease duration, but had more severe neurological impairment. No impact on LUTS was associated with the use of levodopa, anticholinergics, and dopamine receptor agonists. Men and women were similarly affected by urinary symptoms. Conclusions: The severity of the neurological disease is the only predictive factor for the occurrence of voiding dysfunction, which affects men and women alike. Neurourol. Urodynam. 28:510–515, 2009. ß 2009 Wiley-Liss, Inc. Key words: bladder dysfunction; etiology; Parkinson’s disease INTRODUCTION Lower urinary tract symptoms (LUTS) are frequent in patients with Parkinson’s disease (PD). It is estimated that 27–70% of PD patients present LUTS during the course of their disease. 1,2 Several factors account for the high prevalence of LUTS among patients with PD, including vesicosphincteric abnormalities secondary to the neurological disease, urinary tract comorbidities such as prostate diseases and degenerative alterations in the urinary tract associated with aging. Thus, it is difficult to establish the role played by each one of these factors in the genesis of LUTS. Different authors have investigated the association between LUTS and parameters such as age, severity of neurological impairment, and disease duration in patients with PD, with somewhat controversial results. Some studies have shown an association between LUTS and PD severity 1,3,4 while others failed to do so. 5–7 Likewise, an association between age and LUTS has been shown in PD patients 5 but was not confirmed in other series. 1,3 Few studies have evaluated gender differences in terms of urinary dysfunction in PD patients. 1,8 Since PD affects mainly elderly patients, a multifactorial etiology is expected for their voiding dysfunction. One could expect an increased preva- lence of voiding symptoms (ICSV) in men with PD as compared to women, due to the coexistence of benign prostatic hyper- plasia in a significant proportion of the male patients. However differences between men and women with PD in terms of LUTS remain poorly investigated. The aim of this study was to determine the prevalence and characteristics of LUTS in patients with PD and examine the associations between LUTS and age, gender, disease duration, degree of neurological impairment, and impact on quality of life (QOL). MATERIALS AND METHODS From January 2003 to January 2006, we prospectively evaluated 113 consecutive patients with PD recruited from our Neurology Department Clinic. All patients had an established diagnosis of PD 9 and were invited to participate irrespective of the presence of urinary symptoms. Inclusion criteria included idiopathic PD and age above 40 years. Exclusion criteria included the association of neurological disorders, use of any bladder or prostate medications for the past 6 months, and history of pelvic or prostate surgery and pelvic radiotherapy. Two patients who were receiving antimuscarinic agents and one who was taking an alpha-blocker were excluded. This study was approved by the Institutional Review Board of our hospital. Patients agreed to participate after full disclosure of its purpose and written informed consent was obtained from all. A total of 84 (76.3%) men and 26 (23.7%) women, with a mean age of 61.8  9.6 years (range 42–78 years) were evaluated. The mean duration of the illness was 12.3  7.2 years (range 1–35 years). Conflict of interest: none. *Correspondence to: Cristiano M. Gomes, MD, Hospital das Clinicas da Universidade de Sao Paulo, Divisao de Clinica Urologica, Caixa Postal: 11273-9, CEP: 05422-970 Sao Paulo, SP Brazil. E-mail: crismgomes@uol.com.br Received 30 July 2008; Accepted 31 October 2008 Published online 3 February 2009 in Wiley InterScience (www.interscience.wiley.com) DOI 10.1002/nau.20681 ß 2009 Wiley-Liss, Inc.