Sacral Nerve Stimulation in Parkinson's Disease Patients with Overactive Bladder Symptoms.

To assess the efficacy, safety, and outcomes of sacral nerve stimulation (SNS) for Parkinson's Disease (PD) patients with overactive bladder (OAB) symptoms.

We retrospectively reviewed PD patients who underwent Stage I SNS. Demographics, urodynamic data, and baseline voiding function were analyzed. Efficacy and safety of treatment were determined by rate of progression to Stage II, explantation, and surgical revision. Long-term outcomes were assessed using voiding diaries and/or clinic notes.

60% (9/15) experienced ≥50% improvement in urinary parameters and proceeded to Stage II. There was no significant difference in age, BMI, comorbidities, PD disease duration, or levodopa equivalent daily dose between successful and non-successful Stage I patients. However, 100% of female patients experienced Stage I success compared to 44% of male PD patients (p=0.04). Individuals with >12-month follow-up experienced an average reduction of 6 voids/day. No patients required revision or explantation of their device at latest clinic follow-up (22.2 ± 7.8 months). Higher maximal urethral closure pressures (MUCP), detrusor pressure at maximum flow rate (PdetQmax), post-void residual (PVR) volume, and mean BOOI were observed in the Stage I trial failures.

At our institution, PD patients have a similar rate of progression to Stage II compared to the general population. SNS is an effective therapy that should be considered among the treatment options for PD patients with OAB symptoms. Urodynamic parameters associated with obstruction may be predictive of SNS failure in PD patients and may help guide patient selection, however further studies are needed.

Urology. 2020 Jul 15 [Epub ahead of print]

Daniel R Greenberg, Ericka M Sohlberg, Chiyuan A Zhang, Veronica E Santini, Craig V Comiter, Ekene A Enemchukwu

Stanford University School of Medicine, Department of Urology, 300 Pasteur Drive, Stanford, CA, 94305, USA. Electronic address: ., Stanford University School of Medicine, Department of Urology, 300 Pasteur Drive, Stanford, CA, 94305, USA. Electronic address: ., Stanford University School of Medicine, Department of Urology, 300 Pasteur Drive, Stanford, CA, 94305, USA. Electronic address: ., Stanford University School of Medicine, Department of Neurology and Neurological Sciences, 300 Pasteur Drive, Stanford, CA, 94305, USA. Electronic address: ., Stanford University School of Medicine, Department of Urology, 300 Pasteur Drive, Stanford, CA, 94305, USA. Electronic address: ., Stanford University School of Medicine, Department of Urology, 300 Pasteur Drive, Stanford, CA, 94305, USA. Electronic address: .