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AUA 2019

AUA 2019: Sacral Neuromodulation in Parkinson's Disease Patients with Neurogenic Bladder

Chicago, IL (UroToday.com) This was a retrospective study which reviewed Parkinson's Disease (PD) patients with neurogenic OAB who underwent stage I Sacral neuromodulation (SNS) at our institution between 2008-2018. This study investigates the efficacy and long-term outcomes of SNM in PD patients with neurogenic OAB. Urodynamic data and baseline voiding function were analyzed. Efficacy and safety of treatment were determined by evaluating rates of progression to stage II SNS, explantation rate, and need for subsequent therapy. Clinical improvement was assessed using voiding diaries obtained at one month, and every three months after permanent placement.

There were 14 PD patients who underwent stage I SNS, eight (57%) of whom experienced >50% symptomatic improvement and proceeded to permanent implantation. There was no significant difference in age, BMI, comorbidities, pre-treatment OAB regimens, or PD severity between successful and non-successful stage I patients. Pre-treatment urodynamic data revealed a trend showing lower maximum urethral closure pressures (37.8±8.8 cm H2O vs 101.7±31.3 cm H2O, p=0.06) and lower maximum detrusor pressure at a maximum flow rate (22.5±6.2 cm H2O vs 50.4±9.5 cm H2O, p=0.07) among successful stage I patients compared to non-successful stage I patients. Patients that progressed to stage II implantation experienced statistically significant improvements in both nocturia and urinary frequency, with decreased urinary frequency up to 18 months after permanent placement compared to baseline (7.7±0.8 voids/24 hours vs 15.6±2.2 voids/24 hours, p < 0.05). No patients required an explanation of their SNM device.

They concluded that at their institute, PD patients have a lower rate of progression to stage II compared to the general population. However, successful stage I PD patients experience long-term improvement in OAB symptoms. This study also suggests that pre-treatment urodynamics may help clinicians predict successful PD candidates for SNS prior to the stage I trial period. Larger trials are needed to further investigate these trends

Presented by: Daniel Greenberg, MD, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 

Co-authors: Ericka Sohlberg, Chiyuan Zhang, Craig Comiter, Ekene Enemchukwu, Stanford, CA

Written by: Bilal Farhan, MD, Clinical Instructor, Female Urology and Voiding Dysfunction, Department of Urology, University of California, Irvine @BilalfarhanMD at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois