Study design, materials and methods
We present the preliminary results of an ongoing study about lower tract urinary symptoms in patients with Parkinson's disease, utilizing specific gender scores for each sample. For male patients we used IPSS (International Prostate Symptom Score) and for female patients the ICIQ OAB (International Consultation on Incontinence Questionnaire Overactive Bladder), both validated in brazilian portuguese.
We included all patients with previous indication for deep brain stimulation surgery. Patients with active urinary tract infection, diabetes, another neurologic condition or previous pelvic/prostate surgery were excluded. The questionnaires were filled before surgery and at least 03 months after the procedure, enough time to the patient adapt to new electrode parameters. Figure 1 (table 1)
Results
The only male patient (JCO), 56 years, preoperative had only scored in two irritative symptoms: frequency (2 points) and urgency (4 points). The post operative IPSS was 0 in all questions. Since the patient did not scored in any of the obstructive symptoms, we had one less possible confounding bias. See figure 1 (table 2)
On the female spectrum, MJSO, 56 years, showed little improvement pre and post operative. Only frequency and continence showed difference. See Figure 2 (table 2)
The other two patients (JR, 49 years and IMBZ, 73 years) demonstrated a small worsening in all symptoms, except continence, which kept stable after the surgery. See figure 2 (table 3 and 4)
Interpretation of results
Although only 4 patients were analyzed in the study, this goes against the new studies trends [1]: We expected the female population benefiting more in the urologic aspect with DBS than the male ones.
What we observed so far, was mixed results in the female population. The small difference in response may be duo different perception in the symptoms intensity (only one point separates before and after in all symptoms). In the other hand, the male patient showed significant improvement, especially in urgency.
Concluding message
In the scientifc database, there was some evidence suggesting benefit after deep brain stimulation surgery in lower urinary tract symptoms in patients with parkinson's disease. However, most of the studies utilize the UPDRS (Unified Parkinson's disease rating scale) to evaluate that [2]. In this questionnaire, the urinary component presents as only one question.
Although we do observe in our practice some patients reporting partial relief in urinary symptoms after deep brain stimulation surgery, we did not find many studies using specific tools to asses those symptoms[3].
Our goal is to peform a cohort to help identify a possible advantageous effect, and even if this is only a preliminary study, we expect to show concrete results with a reasonable sample and adequate statistical analysis within a year.