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Guillot-Tantay C. Management of lower urinary tract symptoms in Parkinsonian disorders. Rev Neurol (Paris) 2024; 180:101-106. [PMID: 38092575 DOI: 10.1016/j.neurol.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION The aim of the study was to present a narrative review of the literature on the management of lower urinary tract symptoms (LUTS) in patients presenting Parkinsonian disorders (PD). MATERIAL AND METHODS We carried out a literature search in PubMed and Embase database, without time restriction. We used keywords and free-text words around "Parkinsonian disorders" AND "lower urinary tracts symptoms" without language restriction. We focused mainly on papers less than 10 years old. We included all studies evaluating LUTS in patients with PD. RESULTS For the diagnostic management, authors emphasized the importance of differentiating Parkinson's disease with symptoms of bladder overactivity from multiple system atrophy with symptoms of bladder hypoactivity. Urodynamic evaluation was noted as the key element of diagnostic management. The therapeutic management proposed was symptomatic, based on functional urology techniques for the treatment of LUTS, both with drugs (especially anticholinergics) or surgery (intradetrusor injections of botulinum toxin, neuromodulation). Moreover, it was pointed out that it is always necessary to take into account the existence of a possible associated uropathy (prostate adenoma or pelvic prolapse). CONCLUSION Urodynamic evaluation is the cornerstone of diagnostic management of LUTS in patients with PD. Therapeutic management is above all symptomatic and must be done in a collegial way involving the urologist, neurologist, gynecologist, and physical medicine and rehabilitation physician.
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Affiliation(s)
- C Guillot-Tantay
- Service d'urologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
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Stalder SA, Gross O, Anderson CE, Bachmann LM, Baumann S, Birkhäuser V, Bywater M, Del Popolo G, Engeler DS, Agrò EF, Friedl S, Grilo N, Kiss S, Koschorke M, Leitner L, Liechti MD, Mehnert U, Musco S, Sadri H, Stächele L, Tornic J, van der Lely S, Wyler S, Kessler TM. bTUNED: transcutaneous tibial nerve stimulation for neurogenic lower urinary tract dysfunction. BJU Int 2023; 132:343-352. [PMID: 37204144 DOI: 10.1111/bju.16081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To present the protocol for a randomized controlled trial (RCT) evaluating the efficacy and safety of transcutaneous tibial nerve stimulation (TTNS) for refractory neurogenic lower urinary tract dysfunction (NLUTD). STUDY DESIGN AND RESULTS bTUNED (bladder and TranscUtaneous tibial Nerve stimulation for nEurogenic lower urinary tract Dysfunction) is an international multicentre, sham-controlled, double-blind RCT investigating the efficacy and safety of TTNS. The primary outcome is success of TTNS, defined as improvements in key bladder diary variables at study end compared to baseline values. The focus of the treatment is defined by the Self-Assessment Goal Achievement (SAGA) questionnaire. Secondary outcomes are the effect of TTNS on urodynamic, neurophysiological, and bowel function outcome measures, as well as the safety of TTNS. CONCLUSIONS A total of 240 patients with refractory NLUTD will be included and randomized 1:1 into the verum or sham TTNS group from March 2020 until August 2026. TTNS will be performed twice a week for 30 min during 6 weeks. The patients will attend baseline assessments, 12 treatment visits and follow-up assessments at the study end.
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Affiliation(s)
- Stephanie A Stalder
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Collene E Anderson
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Swiss Paraplegic Research, Nottwil and Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Sarah Baumann
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Mirjam Bywater
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Giulio Del Popolo
- Department of Neuro-Urology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Daniel S Engeler
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Enrico Finazzi Agrò
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Tor Vergata University, Rome, Italy
| | - Susanne Friedl
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Nuno Grilo
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephan Kiss
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Miriam Koschorke
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stefania Musco
- Department of Neuro-Urology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Helen Sadri
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lara Stächele
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jure Tornic
- Department of Urology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stéphanie van der Lely
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stephen Wyler
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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McClurg D, Elders A, Hagen S, Mason H, Booth J, Cunnington AL, Walker R, Deane K, Harari D, Panicker J, Stratton S, McArthur J, Sellers C, Collins M. Stimulation of the tibial nerve-a randomised trial for urinary problems associated with Parkinson's-the STARTUP trial. Age Ageing 2022; 51:afac114. [PMID: 35704616 PMCID: PMC9200143 DOI: 10.1093/ageing/afac114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND non-motor symptoms such as bladder dysfunction are common (80%) in people with Parkinson's increasing the risk for falls with a negative impact on health-related costs and quality of life.We undertook STARTUP to evaluate the clinical and cost-effectiveness of using an adhesive electrode to stimulate the transcutaneous tibial nerve stimulation (TTNS) to treat bladder dysfunction in people with Parkinson's disease (PD).Study design, materials and methods: STARTUP was a parallel two-arm, multi-centre, pragmatic, double-blind, randomised controlled trial. Each participant attended one clinic visit to complete consent, be randomised using a computer-generated system and to be shown how to use the device.The trial had two co-primary outcome measures: International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and the International Prostate Symptom Score (IPSS). These were completed at baseline, 6 and 12 weeks. A bladder frequency chart and resource questionnaire were also completed. RESULTS two hundred forty two participants were randomised. About 59% of participants were male, the mean age was 69 years and mean time since diagnosis was 6 years. Questionnaire return rate was between 79 and 90%.There was a statistically significantly lower score in the active group at 6 weeks in the IPSS questionnaire (mean difference (Standard deviation, SD) 12.5 (6.5) vs 10.9 (5.5), effect size -1.49, 95% CI -2.72, -0.25). There was no statistically significant change in any other outcome. CONCLUSION TTNS was demonstrated to be safe with a high level of compliance. There was a significant change in one of the co-primary outcome measures at the end of the treatment period (i.e. 6 weeks), which could indicate a benefit. Further fully powered RCTs are required to determine effective treatments.
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Affiliation(s)
- Doreen McClurg
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Andrew Elders
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Suzanne Hagen
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Jo Booth
- Scholl of Health & Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | | | | | - Katherine Deane
- School of Nursing Sciences, University of East Anglia, NR4 7TJ, Norwich
| | - Danielle Harari
- Guy’s & St Thomas Hospital NHS Foundation Trust, SE1 7EH, London
| | - Jalesh Panicker
- University College London Hospitals NHS Foundation Trust, WC1E 6BT, London
| | - Susan Stratton
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Jaclyn McArthur
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Ceri Sellers
- NMAHP RU, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Marissa Collins
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow G4 0BA, UK
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Abstract
Advanced Parkinson's disease (PD) often brings a set of motor and non-motor features that are particularly challenging to manage. Medication options can be limited by side-effects and quality of life can be severely affected by an accumulating burden of nonmotor symptoms. Here, we reviewed the literature and our clinical experience with the aim of providing a practical approach to the management of advanced PD. We provide guidelines for treatment of physical and neurobehavioral concerns, that occur in advanced PD.
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Autonomic Dysfunctions in Parkinson's Disease: Prevalence, Clinical Characteristics, Potential Diagnostic Markers, and Treatment. PARKINSON'S DISEASE 2021; 2020:8740732. [PMID: 33425317 PMCID: PMC7775181 DOI: 10.1155/2020/8740732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease in the middle-aged and the elderly. Symptoms of autonomic dysfunctions are frequently seen in PD patients, severely affecting the quality of life. This review summarizes the epidemiology, clinical manifestations, and treatment options of autonomic dysfunctions. The clinical significance of autonomic dysfunctions in PD early diagnosis and differential diagnosis is also discussed.
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Abstract
Recognition of the importance of nonmotor dysfunction as a component of Parkinson's disease has exploded over the past three decades. Autonomic dysfunction is a frequent and particularly important nonmotor feature because of the broad clinical spectrum it covers. Cardiovascular, gastrointestinal, urinary, sexual, and thermoregulatory abnormalities all can appear in the setting of Parkinson's disease. Cardiovascular dysfunction is characterized most prominently by orthostatic hypotension. Gastrointestinal dysfunction can involve virtually all levels of the gastrointestinal tract. Urinary dysfunction can entail either too frequent voiding or difficulty voiding. Sexual dysfunction is frequent and frustrating for both patient and partner. Alterations in sweating and body temperature are not widely recognized but often are present. Autonomic dysfunction can significantly and deleteriously impact quality of life for individuals with Parkinson's disease. Because effective treatment for many aspects of autonomic dysfunction is available, it is vitally important that assessment of autonomic dysfunction be a regular component of the neurologic history and exam and that appropriate treatment be initiated and maintained.
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Affiliation(s)
- Ronald F Pfeiffer
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA.
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