Background:
Lower urinary tract
dysfunction is often occurs in patients with Parkinson's disease (PD) that is
primarily induced by
neurogenic detrusor overactivity (NDO). Objective: To evaluate the clinical and urodynamic effects of
posterior tibial nerve stimulation (PTNS) on NDO of PD patients. Methods: Thirty-three patients with PD and
were subjected to weekly treatment with percutaneous PTNS for 12 weeks. The
clinical manifestations such as nocturia, frequency of micturition and
incontinence episodes were analyzed before and after PTNS using voiding diary,
international prostate symptom (IPSS) and quality of life (QOL) scores. Filling and voiding cystometry were done for
comparison of the urodynamic parameters suggestive of NDO namely volume at
first involuntary detrusor contraction (1st IDCV), maximum detrusor
pressure (Pdetmax) and maximum cystometric capacity (MCC).
Result: Frequency and leakage episodes have
significantly decreased from a mean of 10.5±2.1 and 3.5±1.0 to a mean of
7.8±1.2 and 2.2±0.7 respectively (P<0.01). Meanwhile nocturia decreased from
3.4±0.8 to 2.1±0.8 (P=0.06). IPSS and QOL were significantly better after PTNS.
Likewise, urodynamic parameters also significantly improved. Mean 1st
IDCV and MCC significantly increased after PTNS from a mean of 150.6±46.6 and
232.9±63.1 to 271.3±67.3 and 329.1±65.7 respectively (P<0.01). No serious
adverse events or side effects were observed during or after treatment. Conclusion: The use of PTNS in IPD patients
with overactive bladder are encouraging for amelioration of detrusor
overactivity and improving bladder storage symptoms. However, long-term
follow-up is needed for planning to maintenance protocols. [Egypt
J Neurol Psychiat Neurosurg. 2013; 50(3): 265-270]
Key
Words:
Parkinson's disease, detrusor overactivity, posterior tibial nerve stimulation.
Correspondence to Ehab S. Mohammed, Department of Neurology,
Tanta University Egypt.
Tel:
+201144656670
E-mail:ehab_metwally70@yahoo.com