Objective: Describe the interdisciplinary actions that resulted in the therapeutic indication of a clean intermittent bladder catheterization in a patient with detrusor areflexia related to PD. 

Background: Bladder dysfunction is present in up to 96% of Parkinson’s disease (PD) patients and its pathophysiological mechanisms culminate in storage and voiding symptoms¹. Voiding symptoms can be related to detrusor areflexia, witch is considered a rare dysfunction in PD with the recommended treatment the intermittent bladder catheterization².

Methods: Case report.

Results: The patient was a 66-years-old man with idiopathic PD with the onset of his symptoms in 2002. He developed progressive worsening of symptoms with rigidity, resting tremor, bradykinesia, hypophonia, hyposmia, hypomimia, imbalances, constipation, erectile dysfunction, “on–off” phenomenon, dyskinesia and urinary incontinence. As an associated disease, he had high blood pressure. The following medications were used by the patient daily: 750/100 mg of Levodopa/Carbidopa, 2 mg of Pramipexol, 100/25 mg of Levodopa/Benserazida HBS, 0.5/0.4 mg of Dutasteride/Tamsulosin Hydrochloride, 1.5 mg of Indapamide, and Macrogol 3350. The voiding diary showed urinary volumes between 150 and 200 ml and residual post-voiding highs varying from 498 to 663 ml. The urodynamic data identified decreased bladder sensitivity, cystometric capacity and preserved bladder compliance and increased post-voiding residual (540 ml). Based on these results, the interdisciplinary team indicated clean intermittent catheterization as a treatment for bladder arreflexia in patients with PD. However, the patient refused to perform the procedure for four years, because of urethral sensitivity present, accepting this intervention only in 2015 after presenting the third episode of urinary tract infection. 

Conclusions: This research provides concepts about an unusual symptom (detrusor areflexia) and a practice report infrequently (intermittent bladder catheterization) in patients with PD. The main limitation was that the patient did not exhaust the last diagnostic feature that clinically establishes idiopathic PD (the myocardial scintigraphy). Nevertheless, this report encourages discussions concerning the importance of comprehensive individualized and interdisciplinary care, and contributes to the advancement of scientific knowledge regarding the treatment and prevention of urinary dysfunctions in PD.

References: Araki I, Kitahara M, Oida T, Kuno S. Voiding dysfunction and Parkinson’s disease: urodynamic abnormalities and urinary symptoms. J Urol. 2000:164(5);1640-3. 

Newman DK, Wilson MM. Review of intermittent catheterization and current best practice practice. Urol Nurs. 2011:31(1);12-29

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clean-intermittent-catheterization-in-parkinsons-disease-a-case-report/