OBJECTIVE: To investigate effects of Percutaneous Tibial Nerve Stimulation (PTNS) on Parkinson’s Disease (PD) patients with lower urinary tract symptoms (LUTS) of the filling phase, but presenting significant post-void residual urine.
MATERIALS AND METHODS: Patient population consisted of 7 male PD patients (mean age 64 yrs. + 7), all affected by idiopathic PD with a Hohen and Yarh score lower than 2.5 and a mean disease duration of 3.8 + 1.1 years. All patients presented with filling phase LUTS, but also showed a significant (>70 ml) post-void residual urine. All had previously been treated with conventional treatments (drugs, behavioral therapy, rehabilitation protocols) with unsatisfactory results. PTNS therapy consisting of 10-12, 30-minutes stimulation sessions was performed according to the technique described by Vandoninck. Patients were evaluated before and after PTNS therapy using voiding diaries, I-QoL and urodynamics. Response was defined as a >50% reduction in micturitions or, if incontinent, of incontinence episodes.
Two incontinent and 3 other patients responded to PTNS therapy. Four of 5 responders, but none of the 3 non-responders, were diagnosed as having a urethral sphincter bradykinesia during bladder voiding phase (p=0.01). Responders showed a statistically significant improvement in number of incontinence episodes/day (3 incontinent patients only) from 5 to 1 (p=0.01); number of micturitions episodes/day from 10 to 7 (p=0.02); I-QoL from 69 to 89 (p=0.02); Q max (ml/s) 10 to 14 (p=0.03); residual urine (ml) 100 to 20 (p=0.01) and cystometric bladder capacity (ml) 220 to 315 (p=0.03).
CONCLUSION: PTNS has been shown to be effective in up to 70% of PD patients with filling phase LUTS. These data suggest an important role of PTNS in the treatment of PD patients with filling phase symptoms and concomitant urinary retention. Urethral sphincter bradykinesia could be positive predictive factor for success of the treatment.
Source: Uroplasty summary of original poster