SUFU 2019: Sacral Neuromodulation in Patients with Parkinson’s Disease: A Multicenter Study

Miami, FL ( Storage lower urinary tract symptoms (LUTS) are common in patients with Parkinson’s Disease, and urinary complaints in this group have been challenging to manage. Prior studies have shown limited efficacy in conservative management of LUTS in Parkinson’s Disease patients. To date, there has been no series examining the outcomes of sacral neuromodulation (SNM) in Parkinson’s Disease.

In a multi-institutional and multi-national study at NYU and 5 French academic departments of urology, the use of SNM in Parkinson’s Disease patients was described by Benoit Peyronnet, MD, of the University of Rennes, France. Included in the retrospective study were all Parkinson’s Disease patients who underwent Stage 1 SNM or percutaneous nerve evaluation (PNE) between 2008 and 2018. Patients with Parkinsonism were excluded from the analysis. Full implantation of the InterStim device was performed if patients reported an improvement of storage LUTS > 50% during Stage 1 SNM or PNE.

After exclusion of 5 patients with Parkinsonism, there were a total of 20 patients included in the study. The median age of patients was 74 years, with 8/12 (60%) male and 4/12 (40%) female. All had been refractory to antimuscarinics, and 88% had exhibited detrusor overactivity on preoperative urodynamic testing. No patients had bowel dysfunction at baseline. 6/20 (30%) of patients underwent PNE, and 14/20 (70%) had undergone Stage 1 SNM.

Thirteen patients (65%) had a >50% improvement after a median duration of 8.7 days during the testing phase. They consequently went on with full implantation of the InterStim device. No postoperative complication was noted after any of the procedures.

After a median follow-up of 20 months following Stage 2 InterStim implantation, only seven patients reported their storage LUTS were improved > 50% compared to baseline (intent to treat efficacy=35%) with a statistically significant difference between those who had undergone PN vs. Stage 1 SNM (0% vs. 50%; p=0.05). Four explanations of the InterStim device were performed (three for loss of efficacy, and one for discomfort with the device).

In the first series to assess the outcomes of SNM in Parkinson’s Disease patients, the authors concluded that the outcomes observed in Parkinson’s Disease patients following implantation of the InterStim device were inferior compared to what is typically reported in non-neurogenic patients. However, they concluded that further studies should be undertaken to better define the role of SNM in this population.

Presented by: Benoit Peyronnet, MD, The University of Rennes, France 

Written by: Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi