Jozef Marenčák, Rudolf Moro, Eduard Králik, Dymitry Lapatko
Objective: Retrospective evaluation of the effectiveness of conservative and surgical treatment of patients suffering from Parkinson’s disease (PD) and benign prostatic obstruction (BPO) due to benign prostatic hyperplasia (BPH). Material and methods: Between 1. 1. 2005 to 31. 12. 2013 on the Urology department FNsP Skalica a total of 21 men (mean age 74, range 66-79 years) with PD were treated, who had synchronously difficulties due to BPH. All patients were treated initially conservatively – a combination of interventions in lifestyle with the medication regimen (alpha blockers, inhibitors of 5 alpha reductase, antimuscarinics, etc.) and in 9 males transurethral resection of the prostate (TURP) was performed due to failure of conservative therapy. All subjects indicated for TURP were introduced before surgery indwelling permanent catheter for repeated urinary retention. All patients were taking regular medication due to PD. Diagnostic procedures included: medical history, questionnaires (IPSS, OAB, Hoehn Yahr range, etc.) and bladder diaries, physical examination, laboratory evaluation, uroflowmetry, ultrasound scan (postvoid residual determination and assessment of the state of upper urinary tract), complete urodynamic examination (cystometry, electromyography and pressure – flow studies), urethrocystoscopy (in all subjects who were treated with TURP), neurological examination and so on. Obstruction at the bladder neck was assessed by Abrams – Griffiths nomogram. The effect of treatment was monitored at regular intervals on the basis of IPSS, quality of life, bladder diaries, postvoid residual urine etc. The average follow – up time was 64 (range 9-87) months. Results: After pharmacotherapy alone was: improved score of IPPS by an average of 3.4 points in a 6/12 (50 %), reduced of postvoid residual volume of 50 ml, noted a reduction in nocturia about one night micturition in 5/12 (42 %), improved the quality of life of two points in 8/12 (67 %) men with PD and BPO/ BPH. TURP has been effective in 6 out 9 (67 %) patients. Three men had after TURP difficulty maintaining urine and it was necessary for them to reintroduce a urinary catheter. Conclusions: PD in combination with symptomatic BPH requires a primarily conservative approach. Urodynamic examination is required for all patients in particular to confirm BPO and to rule out alternatively other neurological causes. TURP must be consulted with the patients.