Presentation Authors: Daniel Greenberg*, Ericka Sohlberg, Chiyuan Zhang, Craig Comiter, Ekene Enemchukwu, Stanford, CA
Introduction: Parkinson&[prime]s Disease (PD) alters central inhibition of micturition resulting in detrusor overactivity, negatively impacting patients&[prime] functional independence and quality of life. Previous studies examining overactive bladder (OAB) medications on voiding frequency in PD have shown inconsistent results and high rates of adverse events. There is increasing interest in the use of sacral neuromodulation (SNM) in PD patients. This study investigates efficacy and long-term outcomes of SNM in PD patients with neurogenic OAB.
Methods: We retrospectively reviewed PD patients with neurogenic OAB who underwent stage I SNS at our institution between 2008-2018. 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.
Results: 14 PD patients 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 (37.8Â±8.8 cm H2O vs 101.7Â±31.3 cm H2O, p=0.06) and lower maximum detrusor pressure at maximum flow rate (22.5Â±6.2 cm H2O vs 50.4Â±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 (7.7Â±0.8 voids/24 hours vs 15.6Â±2.2 voids/24 hours, p < 0.05). No patients required explantation of their SNM device.
Conclusions: At our institution, 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.