Eight-year H/o Parkinson’...

A 77-year-old man with an eight-year H/o Parkinson’s disease presented with complaints of nocturia (3–4 times nightly), frequency (approximately every two hours), urgency and urgency incontinence. He mentions that he also experiences periodic mild constipation. Nine years ago, he underwent transurethral resection of the prostate (TURP) following the development of benign prostatic hypertrophy and associated lower UTI symptoms. 

His medications included a 5-alpha-reductase inhibitor (dutasteride) and anti-Parkinsonian drugs (levodopa and pramipexole). Cystoscopy and uroflow showed a mild post-void residual (PVR), a uroflow of 8 mL/sec, and 211 mL of voided volume. At that time, he has prescribed long-acting tolterodine 4 mg daily. A few months later, his neurologist initiated the cholinesterase inhibitor donepezil, 10 mg daily. 

At the next urology appointment, video UDS demonstrated difficulty filling due to leakage and instability (60 cm H2O).