Relationship between nigrostriatal dopaminergic degeneration, urinary symptoms, and bladder control in Parkinson’s disease K. Winge a , L. Friberg b , L. Werdelin a , K. K. Nielsen c and H. Stimpel c a Department of Neurology, H:S Bispebjerg University Hospital, Copenhagen NV, Denmark; b Department of Clinical Physiology and Nuclear Medicine, H:S Bispebjerg University Hospital, Copenhagen NV, Denmark; and c Department of Urology, H:S Frederiksberg University Hospital, Frederiksberg, Denmark Keywords: bladder dysfunction, Parkinson’s disease, SPECT, urodynamics Received 24 September 2004 Accepted 2 November 2004 Patients with Parkinson’s disease (PD) often have lower urinary tract symptoms (LUTS). Studies have indicated a correlation between dopaminergic degeneration and LUTS and presence of overactive bladder. We evaluated 18 patients with Parkinson’s disease using single-photon emission computerized tomography (SPECT) imaging of the dopamine transporter with [ 123 I]-FP-CIT, and bladder symptoms were assessed using questionnaires and full urodynamic evaluation both in medicated state and after cessation. Bladder symptoms correlated with age, stage and severity of disease but not with uptake of the ligand in the striatum. Patients with bladder symptoms had a significant lower uptake in the striatum compared with patients without LUTS. In patients with severe bladder dysfunction, LUTS correlated with putamen/caudate ratio. The specific binding of the ligand did not correlate with urodynamics para- meters or any change in these after wash-out. Our findings suggest that the presence of LUTS is associated with the degeneration of the total number of nigrostriatal dop- aminergic neurones, whilst the severity of bladder dysfunction is correlated with the relative degeneration of the caudate nucleus. The effects of medication on bladder control, as evaluated by urodynamics are believed to involve structures outside the basal ganglia. Introduction Patients with Parkinson’s disease (PD) often have lower urinary tract symptoms (LUTS). In the studies most recently published on PD patients diagnosed according to published criteria, the prevalence of urinary symp- toms is 27% (Araki and Kuno, 2000) to 39% (Campos- Sousa et al., 2003) based on validated questionnaires. PD-patients have significantly more symptoms than healthy control persons (Lemack et al., 2000; Campos- Sousa et al., 2003). Typically, the bladder symptoms appear after treat- ment for PD has been started(Chandiramani et al., 1997; Araki and Kuno, 2000). Araki and Kuno found a clear correlation with neurological disability(Araki and Kuno, 2000), and Sakakibara et al demonstrated a correlation to stage of PD (Sakakibara et al., 2001a). Both reports suggest a relationship between dopamin- ergic degeneration and symptoms of urinary dysfunc- tion. Others have not found this correlation (Aranda et al., 1983; Gray et al., 1995; Campos-Sousa et al., 2003). Animal studies have demonstrated a clear cor- relation between dopaminergic degeneration and the presence of overactive urinary bladder (Yoshimura et al., 1993). In PD patients, there is a reduced binding of specific radio-labelled ligands to the pre-synaptic dopamine transport sites (DAT). In PD patients with additional urinary bladder symptoms, there is an augmented reduction of the DAT ligand [ 123 I]-b-CIT binding in the striatum compared with patients with PD but without bladder dysfunction, thus indicating a correlation between urinary dysfunction and degeneration of the nigrostriatal dopaminergic cells (Sakakibara et al., 2001b). Studies of PD patients with urinary symptoms using urodynamics have shown that the most frequent abnormality is detrusor over activity; the incidence varies from 45 to 93% (Pavlakis et al., 1983; Fitzmau- rice et al., 1985; Christmas et al., 1988; Hattori et al., 1992; Araki et al., 2000). Anti-Parkinson medication seems to have a beneficial effect on the bladder function in some studies, but the results are conflicting (Fitz- maurice et al., 1985; Winge et al., 2002). In this study, we wanted to evaluate the correlation between dopaminergic degeneration in the striatum and bladder symptoms in PD patients. Dopaminergic degeneration was investigated by single-photon emis- sion computerized tomography (SPECT) imaging of the dopamine transporter with [ 123 I]-FP-CIT. Bladder Correspondence: Kristian Winge, Department of Neurology, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark (tel.: +45 35 313 293; fax: +45 35 313 957; e-mail: k.winge@dadlnet.dk). 842 Ó 2005 EFNS European Journal of Neurology 2005, 12: 842–850