Hypothesis / aims of study
As it could cause neurogenic detrusor overactivity, which might impair functional outcomes notably by resulting in de novo or worsened urgency urinary incontinence, surgical treatment of benign prostatic obstruction (BPO) is usually regarded as a risky option in patients with Parkinson’s disease (PD). However, very few series have aimed to assess the outcomes of BPO surgical management in PD patients. The aim of the present study was to assess the outcomes of BPO surgical treatment in PD patients.
Study design, materials and methods
All male patients with a reliable diagnosis of PD who underwent transurethral resection of the prostate (TURP) or photoselective vaporization of the prostate (PVP) for bothersome lower urinary tract symptoms (LUTS) due to BPO between 2010 and 2017 at 3 academic institutions were included in a retrospective study. Patients with doubtful neurological diagnosis (i.e. parkinsonism not formally diagnosed as PD) were excluded. The primary endpoint was clinical success defined as any subjective improvement in LUTS self-assessed by the patients 3 months after TURP or PVP or recovery of spontaneous voiding in patients with refractory urinary retention and indwelling urethral catheter preoperatively. Univariate logistic regression model was used to seek for predictive factors of success.
After exclusion of seven patients with Parkinsonism not formally diagnosed as PD, 42 PD patients were included: 31 and 11 treated with PVP and TURP respectively. At 3 months, 29 patients reported their LUTS had improved (69%), four that they were unchanged (9.5%) and nine that they were worsened (21.5%). The median length of hospital stay was 1 day. Ten patients experienced postoperative complications (23.8%) but with only one (2.4%) major complication (Clavien grade ≥ 3). Ten of the 14 patients with an indwelling catheter preoperatively recovered spontaneous voiding (71.4%). In spontaneous voiders preoperatively, the mean number of nocturia episodes significantly decreased at 3 months (from 3.7 to 2.1 per night; p=0.04) and so did the post-void residual volume (from 138 to 63.9 ml; p=0.008). Fourteen patients (33.3%) required overactive bladder treatments (i.e. anticholinergics, mirabegron, botulinum toxin injection or sacral neuromodulation) for persistent/de novo storage LUTS postoperatively. Out of 16 patients with preoperative incontinence, seven experienced a complete resolution of their incontinence postoperatively (43.8%). Conversely, out of 26 patients with no incontinence preoperatively, three patients reported de novo urinary incontinence lasting over 6 months postoperatively (11.5%). No predictive factors of success were found.
Interpretation of results
Our series confirmed the relatively high success rate of BPO surgical treatment in the selected population of PD patients (i.e. when certain parkinsonian syndrome such as multiple system atrophy has been reliably ruled out by multidisciplinary team involving neurologists). However, conversely to the only series to date having assessed TURP in PD patients, we found a higher risk of de novo urinary incontinence than commonly reported in patients without neurological conditions (11.5%). Further studies are needed to help better identify the risk factors of TURP/PVP failure and de novo incontinence in PD patients.