Use of the membrane filtration technique and Staib agar for the detection of Cryptococcus neoformans in the urine of AIDS patients--a contribution to diagnosis, therapy and pathogenesis of cryptococcosis

For the cultural control of Cryptococcus neoformans (Cr.n.), among the routinely examined standard specimens like CSF, sputum, blood, etc., urine earns special attention. The combination of membrane filtration technique (MFT) and Staib agar for the detection of Cr.n. from body fluids as described by Staib in 1963 was used for the cultural isolation of Cr.n. from urine of AIDS patients. In 3 examplary cases the diagnostic significance of this method could be demonstrated: The brown colour effect (BCE) of Cr.n. of a single CFU, as well as in colonies growing with a high density, was produced on average within 3-5 d/26 degrees C. The method was found to be useful for the evaluation of antimycotic therapy. One example of the survival of a few CFUs of Cr.n. under treatment with fluconazole as compared to the efficacy of therapy with amphotericin B + flucytosine, and one example of a re-emergence of Cr.n. in the urogenital tract after a too short duration of treatment with amphotericin B + flucytosine are shown. For the exclusion of the survival of single CFUs of Cr.n. in the urogenital tract of males, quantities up to 1 l of urine for the combination of MFT and Staib agar are proposed. As a secondary observation, it was found that this diagnostic combination in addition to its primary purpose, can serve to detect the metabolic end products of the human body present in urine which may influence capsule formation of Cr.n. neoformans.     

Persistence of Cryptococcus neoformans in seminal fluid and urine under itraconazole treatment. The urogenital tract (prostate) as a niche for Cryptococcus neoformans

The open questions of the persistence of Cryptococcus neoformans in the urogenital tract under antimycotic treatment can be examined under optimal mycological-diagnostic conditions only. The example of a case of cryptococcosis in an AIDS patient diagnosed and treated with itraconazole in the early secondary stage of cryptococcosis is used to discuss the problems of the persistence of Cr. neoformans involvement in the urogenital tract (prostate). Data from a ten-week follow-up study are presented and discussed. The observations made have shown that itraconazole is effective in all regions of the body, with the exception of the urogenital tract. In addition to clinical examinations, cases treated with itraconazole should be finally subjected to cultural examination of prostatic secretion and/or seminal fluid, to exclude the possible presence of a symptom-free involvement of the prostate by Cr. neoformans.     

Aspergillus Findings in AIDS Patients Suffering from Cryptococcosis Aspergillus-Befunde während des Cryptococcose-Verlaufs bei AIDS-Patienten

Because of the known pathogenicity of Cryptococcus neoformans and of aspergilli depending on defined but different immunodeficiencies of the host, the evaluation of their simultaneous cultural detection in specimens of the respiratory tract of AIDS patients is of epidemiological, diagnostic, pathogenetic and therapeutic interest. In 10 out of 15 AIDS patients the following species of the genus Aspergillus could be isolated either once or repeatedly during the course of Cr. neoformans infections in specimens from the respiratory tract: A. fumigatus, A. flavus, A. nidulans, A. niger and A. glaucus. From the 10 different case reports the conclusion can be drawn that the cultural findings of aspergilli in specimens from the respiratory tract during the course of cryptococcosis were of no pathogenic significance. Rather, they should be interpreted as inhaled and not yet germinated conidia still capable of growth lacking primary pathogenicity for the AIDS patient. The significance of serodiagnosis for the evaluation of the simultaneous occurrence of Cr. neoformans and Aspergillus spp. is demonstrated and discussed.     

Mycological-diagnostic assessment of the efficacy of amphotericin B + flucytosine to control Cryptococcus neoformans in AIDS patients

Abstract: Optimal diagnostic data (microscopy, culture and serology) on 15 cases of Cr. neoformans infection in AIDS patients served as a basis for the preliminary subdivision of the stages of cryptococcosis: Primary (minor involvement of the lungs only) and secondary (hematogenous dissemination with involvement of various organs) stages. Cr. neoformans counts in body fluids and antigen titres in serum and CSF proved to be useful criteria to assess the stage of infection. The efficacy of the combination therapy with amphotericin B + flucytosine seems to be related to the stage of infection. From the mycological point of view, the standard combination of 0.3–0.5 mg/kg BW/d amphotericin B and 150 mg/kg BW/d flucytosine proved to be effective. Data on sensitivity of the agent to amphotericin B and flucytosine are presented in a summarized form. The subjects of duration of therapy, relapse and resistance to flucytosine are commented by means of examples. It should be the aim of an optimal therapy of cryptococcosis to diagnose this mycotic disease in its primary stage. Zusammenfassung: Anhand von 15 Fällen wird versucht, die Cr. neoformans-Infektion AIDS-Kranker in das Primärstadium (alleiniger und geringer Befall der Lunge) und das Sekundärstadium (hämatogene Dissemination mit Befall verschiedener Organe) einzuteilen. Die Keimzahl von Cr. neoformans in Körperflüssigkeiten und der Cr. neoformans-Antigentiter in Serum und Liquor dienten hierbei als die beiden wesentlichen Kriterien zur Einschätzung des Stadiums der Infektion und seiner Therapierbarkeit. Aus mykologischer Sicht erwies sich die Standardkombination von Amphotericin B (0,3–0,5 mg/kg KG täglich) + Flucytosin (150 mg/kg KG täglich) als wirksam. Anhand von Beispielen wird zu den Themen: Dauer der Therapie, Rezidiv und Flucytosin-Resistenz Stellung genommen. über die Empfindlichkeit der Cr. neoformans-Stämme gegen Amphotericin B und Flucytosin (Ancotil ) wird zusammenfassend berichtet. Voraussetzung für eine optimale Therapierbarkeit der Kryptokokkose scheint die Diagnostik dieser Mykose in ihrem Primärstadium zu sein.     

Infection due to Cryptococcus neoformans of unusual morphology in a patient with AIDS

Cryptococcus neoformans with a rare morphology of hand-mirror appearance was demonstrated by direct microscopic preparation of both cerebrospinal fluid (CSF) and sputum of a patient with AIDS. In addition, one to six blastoconidia were seen at the tip of a germ-tube like structure. Cr. neoformans was isolated in pure culture and the identification was confirmed by biochemical and serological tests as well as by animal pathogenicity.     

Staib Agar Supplemented with a Triple Antibiotic Combination for the Detection of Cryptococcus neoformtans in Clinical Specimens: Staib-Agar mit einer Dreifach-Antibiotika-Kombination für den Nachweis von Cryptococcus neoformans in klinischem Untersuchungsmaterial

It was demonstrated that the in vitro growth of a mucoid Escherichia coli strain from the urine of an AIDS patient could disturb the concurrent growth of Cryptococcus neoformans and the development of its brown colour effect (BCE) on Staib agar (syn. Guizotia abyssinica creatinine agar, bird seed agar, niger seed agar etc.) supplemented with penicillin + streptomycin. Owing to the supplementation with the triple antibiotic combination of penicillin + streptomycin + gentamicin and the resulting inhibition of E. coli growth, the formation of an intense BCE of the Cr. neoformans colonies after 3 d at 26 degrees C could be observed. On the same medium supplemented with this triple antibiotic combination 40 Cr. neoformans strains tested showed growth with an intense BCE after 3 d at 26 degrees C; but on Emmons' neutral Sabouraud's dextrose agar (NSDA) supplemented with the same triple antibiotic combination, inhibition of growth was found. For the examination of clinical specimens for Cr. neoformans contaminated with gram-negative rod-like bacteria, Staib agar supplemented with this triple antibiotic combination is proposed. Various antibiotic supplements to primary recovery media for fungi are discussed and ecological interrelations of bacteria and fungi are emphasized.     

Untersuchungen zum Verhalten von Cryptococcus neoformans in Erde

Bei quantitative!! Untersudiungen zur Überlebensdauer von Cr. n. unter Außenwelt-bedingungen wurde unter Verwendung von 2 Stämmen mit unterschiedlicher Bekapselung in künstlich infizierten natürlidi belebten Erd- und Sandproben innerhalb von 12 Mona-ten ständige Verminderung des Gehalts an Cr. n. nachgewiesen. Nach 18 Monaten gelang in keiner Versuchsgruppe mehr der Nachweis vermehrungsfähiger Kryptokokken. Die Bedeutung von Witterungsfaktoren für die unter Außenweltbedingungen gegenüber La-borversuchen verminderte Überlebensdauer von Cr. n. wird diskutiert. Ein Einfluß der unterschiedlichen Bekapselung auf die Absterbegeschwindigkeit bestand nicht. Die Bef unde werden als Unterstützung der Ansicht gewertet, daß unter den gegebenen Verhältnissen Erde nicht als primärer Standort von Cr. n. zu betrachten ist.

Summary

In quantitative studies on the survival of Cr. n. under external environmental conditions 2 strains with differences in encapsulation were used. In artificially infected samples of soil and sand with natural flora a continuous decrease in the number of Cr. n. was demonstrated over a period of 12 months. After 18 months Cryptococci capable of multiplication were no longer demonstrated in any of the experimental groups. The importance of meteorological factors for the reduction of survival of Cr. n. under external environmental conditions – as compared with laboratory conditions – is discussed. Differences in encapsulation did not have any effect on the rate of survival. The findings are regarded as support for the view that under the conditions given soil cannot be termed the primary habitat of Cr. n.     

Rare and unusual tumors of the genitourinary tract.

The entity of small cell undifferentiated carcinoma of the urinary tract is clearly recognized, though treatment still poses considerable difficulties. Small cell undifferentiated carcinoma may lead to systemic symptoms by hormone production, even in patients with localized tumors. The survival rates of adults with Wilms' tumor approach only 50% of those seen in children. Cisplatin may be effective in relapsing patients. Cancer of the female urethra should be treated by combined surgery and radiotherapy. One should differentiate between urachal and nonurachal adenocarcinoma. DNA ploidy seems to be an important prognostic parameter in adenocarcinoma of the bladder. After orchiectomy, adjuvant chemotherapy is recommended even in testis-confined malignant lymphoma. Organ-preserving surgery and radiotherapy should be used in malignant lymphoma of the bladder. Patients with uncommon urologic tumors should be treated at larger cancer centers. Alternatively, the clinician should at least enter relevant information on patients seen with these malignancies into collective databases. This review summarizes the clinical aspects of rare and unusual tumors of the genitourinary tract in adults.     

Detection of Cryptococcus neoformans in Biopsy Specimens from the Spleen and the Liver of AIDS Patients: Critical Comments: Nachweis von Cryptococcus neoformans in Biopsiematerial von Milz und Leber AIDS-Kranker: Eine kritische Stellungnahme

Summary: This article was prompted by a publication describing the use of fluorochrome for rapid detection of Cryptococcus neoformans in the spleen of an AIDS patient In two AIDS patients including the above-mentioned one, cryptococcosis was diagnosed by the author on the basis of biopsy specimens from spleen and liver. The rapid microscopic diagnosis of the pathogen in histological sections stained with HE and PAS as well as in the unstained native preparations was without problems; for this reason, additional methods were found to be unnecessary. Subsequently, in both cases a disseminated cryptococcosis was confirmed miroscopically, culturally and serologically. It is pointed out that for the diagnosis of cryptococcosis in AIDS patients, invasive methods such as spleen and liver biopsy should not be used but recognized cultural and serological methods at an early stage of the fungal infection. Nevertheless, for such mycological diagnosis, special knowledge of differentiating methods is required. Attempts of performing a rapid diagnosis using fluorescence microscopy are considered as dispensable. Zusammenfassung: Anlaß zu vorliegendem Beitrag war eine Veröffentlichung in dieser Zeitschrift, in der die Verwendung von Fluorochrom zur Schnelldiagnose einer Cryptococcus-neoformans-Infektion in der Milz eines AIDS-Patienten, die bereits vom Autor gestellt worden war, beschrieben wurde. Der Autor konnte in Milz- und Leberstanzzylindern von diesem und beim Leberstanzzylinder eines weiteren AIDS-Patienten aus derselben Klinik eine Cryptococcusneoformans-Infektion nachweisen. Die mikroskopische Schnelldiagnose des Erregers in mit HE und PAS angefárbten histologischen Schnitten wie auch in ungefärbten Nativpräparaten bot keine Schwierigkeiten; somit erübrigte sich die Anwendung weiterer mikroskopisch-diagnostischer Verfahren. In beiden Fällen wurde mikroskopisch, kulturell und serologisch eine disseminierte Kryptokokkose festgestellt Invasive Verfahren wie Milz-und Leberpunktion sind somit entbehrlich, denn bewährte kulturelle und serologische Verfahren ermöglichen eine Schnelldiagnose bereits im Frühstadium der Infektion.     

Occurrence of Cryptococcus spp. in excreta of pigeons and pet birds

In pooled samples of faeces from 25 pet bird flocks in Thuringia, a high rate of contamination with Cryptococcus neoformans var. neoformans was found. The prevalence of Cr. neoformans in the bird-breeding establishments correlated with the numbers of the different pet bird species in these flocks. The differentiation between varieties of Cr. neoformans by means of proline assimilation and canavanine resistance detection as well as with the aid of Cr. neoformans factor sera, polymerase chain reaction (PCR) fingerprinting, sequencing of PCR products as well as Fourier transform infrared spectroscopy showed uniform results which also corresponded to the serological differentiation between serovars A and D. A predominance of serovar A could be observed among the pet bird breeding flocks. This corresponded to the frequency distribution of serovars A and D in cases of human diseases in Germany. In 50% of the samples of pigeon excreta examined ( n =30) in Innsbruck (Austria), Cryptococcus albidus could be isolated but not Cr. neoformans . However, this Cryptococcus species is of minor pathogenetic importance for man. Cryptococcus albidus may be clearly distinguished from Cr. neoformans by means of microbiological methods, PCR and Fourier transform infrared spectroscopy.     

Tödliche Meningoenzephalitis durch Cryptococcus neoformans var. neoformans bei einem Mädchen ohne schwerwiegende Immundefekte

Zusammenfassung. Es wird der Verlauf einer Meningoenzephalitis durch Cryptococcus neoformans bei einer 14jährigen Patientin dargelegt. Die mykologischen Untersuchungsbefunde wiesen anfangs einen massiven Befall des Liquors mit Cryptococcus neoformans (ca. 10000 Hefezellen/ml) und wochenlang sehr hohe Cryptococcus -Antigentiter (maximal 1:2048) aus. Eine HIV-Infektion oder andere schwerwiegende Immundefekte konnten ausgeschlossen werden. Die Behandlung der Cryptococcose erfolgte mit der Dreifachkombination Amphotericin B, Flucytosin und Fluconazol. Der Liquor konnte saniert werden. Trotzdem kam es zu erheblichen Läsionen am Gehirn. Die Patientin ist an den Folgen der Pilzinfektion am 74. Behandlungstag verstorben. Der geschilderte Krankheitsverlauf ist Anlaß, auf die Differentialdiagnose, Cryptococcus neoformans -Infektion"bei der chronischen lymphozytären Liquorpleozytose, verbunden mit Hirndruck- und Augensymptomen, hinzuweisen.
Summary. Case report on a lethal meningo-encephalitis due to Cryptococcus neoformans in a 14-year-old girl without serious immunodeficiency inclusive HIV-infection. The detection of high quantities of cells of Cryptococcus neoformans (about 10000/ml) and high levels of Cryptococcus antigen (up to 1:2048) in the cerebrospinal fluid are remarkable. The patient was treated with a triple combination of amphotericin B, flucytosine and fluconazole. After 18 days the cerebrospinal fluid was sterile. Nevertheless considerable lesions of the brain arised. The patient died from the Cryptococcus infection on day 74 of the antimycotic therapy. Cryptococcosis should be included into the differential diagnosis of the chronic lymphocytic pleocytosis of the cerebrospinal fluid connected with symptoms of intracranial pressure and ocular symptoms.     

Seminal Tract Amyloidosis: Synchronous Amyloidosis of the Seminal Vesicles,Deferent Ducts and Ejaculatory Ducts

Senile Seminal Vesicle Amyloidosis (SSVA) increases with age. Involvement of the whole seminal tract, i.e. the seminal vesicles, ejaculatory and deferent ducts was first reported by us in the International Symposium on Amyloidosis 1998. Since then we encountered four more cases of SSVA. In all these cases the ejaculatory and deferent ducts were also involved by amyloid. The amyloid was located mostly sub-epithelially, stained positively with Congo red, gave green birefringence under polarized light and was permanganate sensitive, slightly positive for lactoferrin immunostaining and negative for all known amyloid types. In recent years the amyloid was found to be derived from Semenogelin I, a major constituent of the seminal fluid which is present in the epithelial cells of the seminal vesicle and vas deference. This would explain the deposition of amyloid not only in the seminal vesicles but also in the deferent an ejaculatory ducts which transport the seminal fluid. In a review of the literature we found three more articles on SSVA in which the amyloid was not limited to the seminal vesicles alone. We propose to designate this type of amyloid as “Senile seminal Tract Amyloidosis” (SSTA) instead of “Senile Seminal Vesicle Amyloidosis (SSVA)”.     

The malignant pleural effusion. A review of cytopathologic diagnoses of 584 specimens from 472 consecutive patients

This study reports the cytopathologic diagnoses rendered on all malignant pleural effusions received and processed over a period of 14 years. Specimens of fluid from various body sites (25,464) were examined. Of these, 5888 (23%) were specimens of pleural effusions. Five hundred eighty-four specimens (9.9% of total pleural fluid specimens) taken from 472 patients were diagnosed as containing cancer cells. Of the malignant pleural effusions, 75.7% were classified as carcinomatous in type. Adenocarcinomas comprised 47.4% of the 584 specimens. The groups of large cell undifferentiated carcinoma and lymphoma/leukemia approximated one another in being the second most common cancer groups (14.3% and 15.0%, respectively). For both males and females, the frequency of organ site or primary tumor type was lung (35.6%), lymphoma/leukemia (15.9%), breast (14.8%), female genital tract (8.1%), and gastrointestinal tract (5.9%). Among male patients, the order of frequency was lung (49.1%), lymphoma/leukemia (21.1%), gastrointestinal tract (7.0%), genitourinary tract (6.0%), and malignant melanoma (1.4%). In female patients, the order of frequency was breast (37.4%), female genital tract (usually ovary) (20.3%), lung (15.0%), lymphoma/leukemia (8.0%), and gastrointestinal tract (4.3%). In 48 patients (10.2%) the primary site of neoplasm was never determined. In 90.5% of patients a cytopathologic diagnosis conclusive for cancer was obtained on the first specimen of fluid. There were no false positive diagnoses.     

Osteomyelitis due to Cryptococcus neoformans in advanced age. Case report and review of literature

In an 84-year-old man cryptococcosis with a pronounced osteomyelitic course (involvement of a rib, two thoracic vertebrae, the sacrum and a femur) was diagnosed histologically post mortem, thus directing attention to cryptococcosis in advanced age. The presumptive chronic course of the Cryptococcus neoformans (Cr. n.) infection in this patient was ascribed to chronic kidney failure, diabetes mellitus and chronic obstructive lung disease. Special reference is made to the mycological and radiological diagnosis of cryptococcosis of the bones as well as to its pathogenesis, therapy and epidemiology.     

Fungal infections following heart transplantation.

Following heart transplantation (HTx), patients often suffer from mycoses due to the necessary immunosuppressive treatment to prevent rejection episodes. Oropharyngeal Candida infections which mostly occur after HTx under high-dose immunosuppressive therapy can be avoided and treated successfully by prophylactic medication to be started immediately after transplantation, either by using azoles (e.g. fluconazole) or amphotericin B suspension. Contrary to this, invasive aspergillosis, beginning in the upper respiratory tract and the lung and mostly followed by hematogenous dissemination into various organs, is always a serious disease with high mortality. To avoid this infection, specimens from the respiratory tract, serum and urine should be examined mycologically prior to HTx. After HTx, apart from prophylactic avoidance of exposure to airborne fungal spores, close mycological control is mandatory to detect colonizations by aspergilli early. Timely administration of amphotericin B and 5-flucytosine, i.e. as soon as invasive growth is suspected, enables curative treatment of the often lethal course of this disease, even under immunosuppressive therapy.     

Isolation of Cryptococcus neoformans in Antwerp Zoo's nocturnal house

Cryptococcosis was diagnosed postmortem in a striped grass mouse (Lemniscomys barbarus) housed in the nocturnal department of Antwerp Zoo. Eight of the remaining mice in the cage were captured. Cryptococcus neoformans was isolated from the lung of one animal. Two mice had an elevated serum cryptococcal antigen titre. On examination of the pooled faecal samples collected from 17 animal species housed in 23 cages of the nocturnal department, the pathogenic yeast was isolated from the faeces of the striped grass mice and a degu (Octodon degus). Numerous Cr. neoformans colonies were isolated from a tree-trunk, tree-stumps, and decaying wood collected from a hollow tree used to decorate the animals cage. Subsequent examination in four other cages of the nocturnal department revealed that all the sampled tree-trunks were colonized by Cr. neoformans. The fungus was isolated from the air sampled in the cage of the degu. Air samples collected in the public and service corridors remained negative. All the isolated strains were identified as Cr. neoformans var. neoformans serotype A.     

Cryptococcuria as manifestation of disseminated cryptococcosis: Staib agar as a selective identification medium

We conducted a retrospective study of 58 cases of cryptococcosis (1986-2008) with urine test positive for Cryptococcus sp, in Mycology Laboratory, Santa Casa-Hospital Complex, Porto Alegre, RS, Brazil. The diagnosis of cryptococcuria was based on microscopic examination and culture of urinary sediment. Cryptococcus was isolated from other clinical specimens such as blood, cerebrospinal fluid, ascitic and pleural fluids, respiratory secretions, biopsies of skin, nasal and bone marrow. Cryptocccus neoformans was present in 55 cases and Cryptocccus gattii in three cases. Males predominated (79.3%); age ranged from 12 to 86 years. Acquired Immune Deficiency Syndrome (AIDS) were present in 60.3%, 31.1% did not have AIDS and 5.2% were apparently immunocompetent patients. The most frequent signs and symptoms were headache (53.4%) and fever (51.7%). The most widely used medication was the amphotericin B (43 patients). The mortality rate was 45%. We conclude that the mycological examination of the urine can be an alternative simple, non-invasive and useful in diagnosis of disseminated cryptococcosis, especially when used in conjunction with techniques for demonstration of the capsule (nigrosine) and/or production of melanin in special culture media (Staib agar).     

Papillary tumors of the upper urinary tract: endoscopic methods of diagnosis and treatment

53 patients (31 males and 22 females, age 16-82 years) suspected to have a papillary tumor of the upper urinary tract (UUT) underwent transurethral uretheronephroscopy (n = 49) and percutaneous nephroscopy (n = 4). Preoperative examination included clinical, x-ray, radionuclide, CT and cytological investigations. 11 patients with solitary papillary UUT tumors were studied endoscopically. Transurethral uretheronephroscopy and percutaneous nephroscopy detected UUT tumors in 31 (58.5%) patients. Postoperative period was uneventful. 3, 6, 12 months and later after endoscopic removal of UUT tumors a control examination was made (excretory urography, ultrasound examination, repeated rigid or fibrouretheroscopy, urinary cytological test). 2-8 years after endoscopic removal of the tumors 5 patients were free of the tumors, 5 patients withdrawn from the study. One woman with a recurrent tumor was reoperated endoscopically. The conclusion is that endoscopic methods are most precise and specific for diagnosis of papillary UUT tumors and should terminate preoperative examination to determine therapeutic policy. In indications for organ-saving therapy, endoscopic methods can serve as a method of choice in the treatment of the above patients.     

Isolation of Cryptococcus neoformans var. neoformans from canine otitis

Cryptococcus neoformans was demonstrated in the clinical material of a 15-year-old male dog with a history of chronic otitis externa by employing Helianthus annuus seed agar as a selective medium. The examination of the isolate for sexual compatibility on modified Helianthus annuus seed medium revealed that it belonged to Filobasidiella neoformans var. neoformans 'alpha' mating type. In the authors' view, this appears to be the first report of isolation of Cr. neoformans var. neoformans from diseased ear of a dog.     

Comparative assessment of combined therapy of neurogenic hyperactivity of detrusor in patients with Parkinson's disease

We studied clinical characteristics of voiding disorders to improve treatment results in patients with Parkinson's disease (PD) in 64 PD patients (28 women and 36 men aged 45 to 76 years, mean age 62.5 +/- 9.4 years). Duration of PD was 8.0 +/- 3.4 years, history of voiding disorders--2.1 +/- 0.8 years. Hyperactive urinary bladder was the cause of voiding disorders in all the patients. The examinees have undergone physical examination, microscopic and cultural examination of the urine, ultrasound investigation of the kidneys, urinary bladder and prostate with determination of residual urine, urodynamic examination of the lower urinary tracts. All the patients were divided into four groups. Group 1 of 10 patients received antiparkinsonian therapy which corrected voiding disorders. Group 2 (n = 26) received tolterodin in a dose 4 mg/day, group 3 (n = 14) received oxibutinin in a dose 5 mg/day, group 4 (n = 14) were treated with trospium chloride in a dose 30 mg/day. Thus, initial correction of antiparkinsonian therapy was made in 64 patients, after this correction voiding disorders reduced in 10 patients and no further treatment was needed. Voiding disorders reduced in all 3 groups of patients given the drugs. Cystometric capacity of the bladder increased in all 4 groups from 155 (86-450) ml to 220 (105-530) ml, on the average, and unstable contractions of the urinary bladder decreased from 3.1 (1-8) to 1.6 (0-5). Quality of life in the examinees improved considerably. The data obtained evidence for M-cholino-blockers efficacy in PD patients with unstable detrusor after correction of antiparkinsonean therapy. Two-month course of tolterodin, oxibutinin and trospium chloride significantly reduced symptoms of urination disorders.