Review Article
Characteristics and risk factors of lower urinary tract dysfunction in patients with Parkinson's disease: A systematic evaluation and meta-analysis

https://doi.org/10.1016/j.clineuro.2021.106885Get rights and content

Highlights

  • To systematically evaluate the risk factors of lower urinary tract dysfunction in patients with Parkinson's disease(PD).

  • In total, 1424 patients with PD were included, 696 patients had symptoms of lower urinary tract dysfunction.

  • To provide theoretical basis for clinical medical staff to identify the risk factors of lower urinary tract dysfunction in patients with PD.

Abstract

To systematically evaluate the risk factors of lower urinary tract dysfunction in patients with Parkinson's disease(PD), and to provide theoretical basis for clinical medical staff to identify the risk factors of lower urinary tract dysfunction in patients with PD. From the establishment of the database to January 2021, PubMed, the Cochrane Library, EMBASE, Web of Science, other English database, were searched for literatures about the risk factors of lower urinary tract dysfunction in patients with Parkinson's disease. According to the inclusion and exclusion criteria, after browsing the title, abstract and full text, the high-quality literature in line with the inclusion criteria was selected, and the Newcastle-Ottawa Scale(NOS)document quality evaluation tool was used to evaluate the literature quality and extract the data. The included research results were analyzed by RevMan 5.3 software. A total of 8 studies were included for Meta analysis. The results showed that 7 of the 20 related risk factors were statistically significant, and the statistically significant risk factors were duration of disease [Mean Difference (MD)= 0.59, 95% Confidence Interval (CI) (0.04, 1.14), P < 0.005], age [MD = 2.01, 95%CI (−0.36, 3.34), P < 0.005], Hoehn-Yahr (H-Y) score >2 [Odds Ratio (OR) = 1.56, 95%CI (1.09, 2.23), P < 0.001], sleep disorder [OR = 1.79, 95%CI (1.36,2.35), P < 0.001], constipation [OR = 1.88, 95%CI (1.42,2.48), P < 0.001], unified Parkinson’s disease rating scale (UPDRS III) [MD= 4.43, 95%CI (2.20, 6.66), P < 0.001], Mini-mental state examination (MMSE) [MD = −1.16, 95%CI (1.23, −1.09), P < 0.001]. Age, duration of disease, H-Y score >2, sleep disorder, constipation, higher UPDRS Ⅲ score and lower MMSE score were the risk factors of lower urinary tract dysfunction in patients with Parkinson's disease.

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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