Urodynamic Characteristics And Treatments Of Female Parkinsonian Patients With Lower Urinary Tract Symptoms

Background:Parkinson’s disease(PD)is a common neurodegenerative disease with clinical manifestations including tremor,bradykinesia,postural abnormalities and muscle rigiditytext.In addition to these motor symptoms,PD patients may also appear non-motor symptoms,such as urinary tract symptoms(frequent urination,urgent urination,nocturia,urinary incontinence,dysuria,hesitancy,and incontinence),which is one of the common non-motor symptoms.However,there are few studies in this field,it is important to study the characteristics of urodynamic study in Parkinson’s patients with lower urinary tract symptoms(LUTS)and explore the related therapeutic measures(based on the urodynamic results).Purpose:The purpose of this study was to identify the characteristics of urodynamic study in female patients with Parkinson’s disease with lower urinary tract symptoms through statistical analysis of urodynamic parameters and clinical characteristics,and to explore the effect of related treatment measures(Deep Brain Stimulation)on the improvement of LUTS,hoping to provide reference for the clinical diagnosis and treatment of PD.Methods:We performed a professional urodynamic assessment in 20 female parkinsonian patients with LUTS.Then,the baseline analysis of urodynamic parameters(anal muscle strength,overactive bladder,bladder compliance,maximum urine flow rate,detrusor muscle strength at maximum urine flow rate and residual urine)and clinical characteristics(age,overactive bladder score and quality of life score)were conducted to explore the characteristics of urodynamic study in female parkinsonian patients with LUTS.All of these patients were subsequently treated with deep brain stimulation(DBS,related electrodes were placed into the STN nucleus of the thalamus,which was switched on 1 month after surgery and continuously stimulate the corresponding brain regions),and we followed up these patients to collect relevant case data after 6 months.The factors which influenced the quality of life of patients(based on quality of life score)were explored by constructing unit and multivariate regression model,and the improvement of patients’ LUTS was analyzed to explore the therapeutic effect of DBS before and after surgery.Meanwhile,the urodynamic study results of 30 male parkinsonian patients were also analyzed for a preliminary experimental analysis due to the limitations of data and the characteristics of male.Results:The mean age of the 20 parkinsonian patients was(60.6±6.3)years.Urodynamic study found that 65%(13/20)of the patients had overactive bladder(OAB)and 75%(15/20)had impaired anal sphincter muscle strength.Preoperative median OAB total score and quality of life(QOL)score were 7.5 points and 5.0 points,respectively,and significantly decreased to 3.0 points(P=0.002)and 3.0 points(P=0.001)6 months after DBS treatment.Unit and multivariate regression analysis showed that four items of OAB score(OAB-1:frequent urination;OAB-2:nocturia;OAB-3:urgency;OAB-4:urinary incontinence)were all independent factors affecting QOL score,and the improvement of nocturia and urgency were independent factors affecting the improvement of QOL score.It’s worth noting that the improvement of nocturia had the most significant effect on improving quality of life.After DBS treatment,40%(8/20)of patients had significantly improved their LUTS(QOL score decreased ≥2 points),30%(6/20)had slightly improved their LUTS(QOL score decreased 1 point),and 30%(6/20)had no improvement in their LUTS(QOL score did not change),which was based on QOL socre.No worsening of their LUTS was found after DBS treatment.Conclusions:1.Based on the study population,female parkinsonian patients with LUTS had abnormal urodynamics parameters,including overactive bladder and impaired anal sphincter muscle strength.The urodynamics study showed that the abnormal urodynamic parameters were more likely to be manifested in the urinary storage period(frequent urination,urgent urination,nocturia and urinary incontinence).2.DBS treatment can improve patients’ LUTS,among which the improvement of nocturia and urgency had a great impact on improving patients’ quality of life.