Review ArticleCharacteristics and risk factors of lower urinary tract dysfunction in patients with Parkinson's disease: A systematic evaluation and meta-analysis
Introduction
Previous studies showed that about 30–65% of patients with Parkinson's disease (PD) have lower urinary tract dysfunction [1]. The symptoms mainly include filling symptoms such as nocturnal urination, frequent urination, and urgency urinary incontinence, and urination disorder such as dysuria, prolonged urination. About 50% of patients with advanced PD have obvious lower urinary tract symptoms with detrusor overactivity symptoms [2], and lower urinary tract dysfunction in patients with PD at any stage were poor responsed to drugs [3], [4].
At present, the quality of the research on the risk factors of lower urinary tract dysfunction in Parkinson's disease is uneven and the results are controversial. In addition, the symptoms of motor retardation in most patients with PD deteriorated their lower urinary tract dysfunction symptoms, such as frequent urination and urgency urinary incontinence, resulting in a serious decline in the quality of life of the patients[5]. According to previous research, severity of Parkinson's disease and autonomic nerve disorders were related to the incidence of lower urinary tract dysfunction [6], [7].
Based on previous research, the purpose of this study is to provide theoretical basis for clinical medical staff to evaluate and identify high-risk groups for targeted health education.
Section snippets
Search strategy and data sources
All full-text published randomized and nonrandomized controlled trials comparing age, gender, Duration of disease, education level, age of onset, hypertension, levodopa equivalent dose(LED), constipation, sleep disorders, cardiovascular diseases, fatigue, anxious, depressed, sexual dysfunction, H-Y, MMSE, and UPDRSⅢ between patients with PD who suffer from or not suffer from lower urinary tract dysfunction were included. H-Y score is a simple scale commonly used in the world to measure the
Literature search results
The database search, snowballing, and contact with experts yielded a total of 5423 articles, After excluding 5415 nonpertinent titles or abstracts, 8 studies [9], [10], [11], [12], [13], [14], [15], [16] were retrieved in complete form and assessed according to the selection criteria (Fig. 1). In total, 1424 patients with PD were included, 696 patients had symptoms of lower urinary tract dysfunction.
Quality assessment
All the 8 included articles were analyzed retrospectively. The NOS scores of the included
Duration of disease
Seven articles [10], [11], [12], [13], [14], [15], [16] reported that the duration of disease is a risk factor of lower urinary tract dysfunction in patients with PD. The results of randomized controlled model analysis showed that the difference was statistically significant [MD = 0.59, 95%CI (0.04,1.14), P < 0.005, I2 = 67%], as shown in Fig. 2.
Age
Seven articles [10], [11], [12], [13], [14], [15], [16] reported that age was a risk factor for lower urinary tract dysfunction in patients with PD,
Discussion
The results showed that 7 factors were related to lower urinary tract dysfunction including duration of disease, age, sleep disorder, constipation, Hoehn-Yahr score >2, Unified Parkinson’s disease rating scale (UPDRS III), Mini-mental state examination (MMSE).
With the increase of age and the development of the duration of disease, the clinical symptoms of PD patients are gradually aggravating, and the number of PD patients with voiding dysfunction increased significantly [17], [18]. Robinson [9]
Conclusion
In this study, different risk factors of lower urinary tract dysfunction in patients with PD were analysed. The results showed that age, duration of disease, H-Y score > 2, sleep disorder, constipation, higher UPDRS Ⅲ score and lower MMSE were risk factor of lower urinary tract dysfunction in patients with PD.
CRediT authorship contribution statement
Hongxia Zhuang and Xueqi Wang contributed to planning the study; Xiaolei Jing collected and assembled the data; Hongxia Zhuang and Xueqi Wang contributed to collecting and interpreting the data; Jiajia Yue and Hao Xu contributed to drafting the manuscript; Hongxia Zhuang and Xueqi Wang contributed equally to this work; all authors read and approved the final manuscript.
Acknowledgement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare that they have no conflict of interest.
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