E Savard1, A Declemy2, V Coindreau2, F Babany2, C Chesnel2, A Charlanes2, F Le Breton2, G Amarenco2. 1. Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: etienne.savard@aphp.fr. 2. Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
Abstract
INTRODUCTION: Lower urinary tract symptoms are common in Parkinson diseases, especially chronic urinary retention. In case of significant and symptomatic postvoid residual, a specific treatment is necessary in order to empty the bladder and nowadays the gold standard of such neurogenic bladder is based on self-intermittent-catheterizations, if possible at all. We carried out a retrospective study about feasibility and outcomes of self-intermittent-catheterizations in this population. METHODS: Retrospective study with qualitative and quantitative, clinical and instrumental (urodynamic) assessment, of lower urinary tract symptoms as urinary retention in extrapyramidal syndromes. RESULTS: Overall, 42 patients with parkinsonian syndrome performing self-intermittent-catheterization were assessed. Twenty-one had idiopathic Parkinson's disease, 17 multiple system atrophy, 1 vascular Parkinson, 1 iatrogenic Parkinson and 2 not yet determined parkinsonian syndromes. All the patients had urinary retention characterized by a postvoiding residual volume more than 150mL. All the patients were symptomatic and reported voiding dysfunction (30/42), overactive bladder syndrome (20/42), stress urinary incontinence (6/42). The cystometry showed detrusor overactivity (15/42), bladder-sphincter dyssynergia (15/42), detrusor underactivity (14/42), sphincter deficiency (4/42) or bladder compliance alteration (3/42). Each patient have learned and well controlled self-intermittent-catheterization technique. Fourteen (33%) stopped self-intermittent-catheterization prematurely in the following months because of functional impact of neurological worsening. CONCLUSION: Even if one third of the patients had stopped self-intermittent-catheterization because of neurological deterioration, this technique remains the gold standard for the treatment of urinary chronic retention in parkinsonian patients. LEVEL OF EVIDENCE: 4.
INTRODUCTION: Lower urinary tract symptoms are common in Parkinson diseases, especially chronic urinary retention. In case of significant and symptomatic postvoid residual, a specific treatment is necessary in order to empty the bladder and nowadays the gold standard of such neurogenic bladder is based on self-intermittent-catheterizations, if possible at all. We carried out a retrospective study about feasibility and outcomes of self-intermittent-catheterizations in this population. METHODS: Retrospective study with qualitative and quantitative, clinical and instrumental (urodynamic) assessment, of lower urinary tract symptoms as urinary retention in extrapyramidal syndromes. RESULTS: Overall, 42 patients with parkinsonian syndrome performing self-intermittent-catheterization were assessed. Twenty-one had idiopathic Parkinson's disease, 17 multiple system atrophy, 1 vascular Parkinson, 1 iatrogenic Parkinson and 2 not yet determined parkinsonian syndromes. All the patients had urinary retention characterized by a postvoiding residual volume more than 150mL. All the patients were symptomatic and reported voiding dysfunction (30/42), overactive bladder syndrome (20/42), stress urinary incontinence (6/42). The cystometry showed detrusor overactivity (15/42), bladder-sphincter dyssynergia (15/42), detrusor underactivity (14/42), sphincter deficiency (4/42) or bladder compliance alteration (3/42). Each patient have learned and well controlled self-intermittent-catheterization technique. Fourteen (33%) stopped self-intermittent-catheterization prematurely in the following months because of functional impact of neurological worsening. CONCLUSION: Even if one third of the patients had stopped self-intermittent-catheterization because of neurological deterioration, this technique remains the gold standard for the treatment of urinary chronic retention in parkinsonianpatients. LEVEL OF EVIDENCE: 4.