From central to peripheral: A new perspective on bladder dysfunction in Parkinson disease

As opposed to classical overactive (OAB) symptoms, Parkinson disease (PD) patients often exhibit detrusor hyperreflexia and impaired contractility or underactive bladder. OAB would be more related to central nervous system dysfunction, but nerve damage in peripheral ganglia (eg, pelvic ganglia in the bladder wall) may play a mechanism of dysfunction manifesting as underactive bladder in PD. We propose a novel hypothesis regarding neurogenic urologic dysfunction in PD, suggesting a potential involvement of peripheral nervous system dysfunction in addition to central nervous system dysfunction. This hypothesis emphasizes the significance of investigating peripheral neuron damage in the urinary bladder. We hereby review the relevant neurogenic bladder dysfunction associated with PD, compare and contrast OAB and underactive bladder manifestations and dysfunction, and discuss novel considerations toward this disease with great unmet needs.