Urološki poremećaji u Parkinsonovoj bolesti

master's thesis

• Title (english): Urinary dysfunction in Parkinson's disease
• Author: Amela Karadža
• Mentor: Srđana Telarović (mentor)
• Committee member: Zdravka Poljaković (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Srđana Telarović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Parkinsonova bolest (PB) je kronični neurodegenerativni poremećaj središnjeg
živčanog sustava, koja se karakterističnim simptomima manifestira kao posljedica nedostatka
neurotransmitera dopamina u dijelu mozga odgovornom za kontrolu pokreta.
Mokraćni sustav čine dva bubrega, dva mokraćovoda, mokraćni mjehur i mokraćna
cijev. Organi mokraćnog sustava sudjeluju u reguliranju volumena i sastava tjelesnih
tekućina. Proces kontrole mjehura je vrlo složen i ovisi o integritetu središnjeg i perifernog
živčanog sustava. Stoga ne čudi da u bolesnika s PB, sa štetom na više područja perifernog i
središnjeg živčanog sustava, postoji disfunkcija mjehura.
Urološki poremećaji se u većini slučajeva javljaju u vidu detruzorske hiperaktivnosti
mjehura. Najšire prihvaćena teorija jest da bazalni gangliji inhibiraju refleks mokrenja u
normalnim stanjima putem D1 receptora i da stanično osiromašenje u substantia nigra pars
compacta (SNc) u PB rezultira gubitkom te D1 posredovane inhibicije i time dovodi do
hiperaktivnosti detruzora. Teškoće uklanjanja urina mogu biti uzrokovane sfinkterom koji teži
kontrakciji, kada je mjehur spreman za pražnjenje ili mišićem mjehura koji je preslab da bi
izbacio mokraću.
Nedavne studije ukazuju na frekvenciju da oko 27% do 39% ljudi s PB imaju
prisutnost poremećene funkcije mokraćnog mjehura. Unatoč učestalosti urinarne disfunkcije,
stvarna urinarna inkontinencija je relativno rijetka. Problemi koji se najčešće javljaju su
učestalo noćno mokrenje (do 86%), mokraćna urgencija (33-71%), učestalo mokrenje (16-
68%) i urgentna inkontinencija.
Liječenje ovih disfunkcija mora biti prilagođeno s terapijom za liječenje PB. Svakom
bolesniku treba isključiti zloćudne urološke bolesti (tumor mokraćnog mjehura, karcinom
prostate). Ciljevi dijagnoze i liječenja su kontroliranje nevoljnog mokrenja, potpuno
pražnjenje mjehura te zaštita bubrežne funkcije.

Abstract (english)

Parkinson's disease (PD) is a chronic neurodegenerative disorder of the central
nervous system, which characteristic symptoms manifest as a result of the lack of the
neurotransmitter dopamine in the part of the brain responsible for the control of movement.
The urinary system consists of two kidneys, two ureters, the bladder and the urethra.
Urinary tract organs are involved in regulating the volume and composition of body fluids.
The process of bladder control is very complex and depends on the integrity of the central and
peripheral nervous system. It is not surprising that in patients who have PD, with damage to
multiple areas of the peripheral and central nervous system, there is a dysfunction of the
bladder.
The urinary dysfunctions are in most cases occur in the form of bladder detrusor
hyperactivity. The most widely accepted theory is that the basal ganglia inhibit the micturition
reflex in normal conditions via D1 receptors and that cell depletion in the SNc in PD results in
the loss of the D1 mediated inhibition and thereby leads to overactivity of the detrusor.
Difficulties removing urine can be caused by sphincter that tends to contraction, when the
bladder is ready for emptying or by the bladder muscle that is too weak to eject urine.
Recent studies suggest that the frequency of approximately 27% to 39% of people
with PD have the presence of abnormal bladder function. Despite the prevalence of urinary
dysfunction , the actual urinary incontinence is relatively rare. Problems that commonly occur
are frequent nighttime urination (up 86%), urinary urgency (33-71%), urinary frequency (16-
68%) and urge incontinence.
Treatment of this dysfunction must be customized with the therapy for the treatment of
PD. Each patient should be excluded from malignant urological diseases (bladder cancer,
prostate cancer). The goals of diagnosis and treatment are controlling the unwilling urination,
completely emptying the bladder and the protection of renal function.

• Keywords: Parkinsonova bolest; urinarni sustav; urološki poremećaji u Parkinsonovoj bolesti; antikolinergici
• Keywords (english): Parkinson's disease; urinary tract; urinary dysfunction in Parkinson's disease; anticholinergics
• Language: croatian
• URN:NBN: urn:nbn:hr:105:485788
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-09-28 09:41:01