gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Acute urinary retention after subthalamic nucleus deep brain stimulation

Meeting Abstract

  • J. Schlaier - Klinik für Neurochirurgie, Universitätsklinikum Regensburg
  • M. Lange - Klinik für Neurochirurgie, Universitätsklinikum Regensburg
  • H.-M. Fritsche - Urologie, St. Josef Krankenhaus, Universität Regensburg
  • W. Wieland - Urologie, St. Josef Krankenhaus, Universität Regensburg
  • A. Brawanski - Klinik für Neurochirurgie, Universitätsklinikum Regensburg
  • R. Ganzer - Urologie, St. Josef Krankenhaus, Universität Regensburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP07-12

DOI: 10.3205/09dgnc328, URN: urn:nbn:de:0183-09dgnc3280

Published: May 20, 2009

© 2009 Schlaier et al.
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Outline

Text

Objective: Deep brain stimulation improves not only motor symptoms in Parkinson’s disease but also urinary function by increasing bladder capacity and reducing urgency. There are no data in the current literature describing deteriorated bladder function after DBS in patients with preoperatively normal bladder function. We report on two patients who experienced acute urinary retention for several weeks after DBS.

Methods: Surgery planning was based on T1 and T2-weighted MR images. The target point in the subthalamic nucleus (STN) was located on axial T2-weighted slices. Multiple microelectrode recordings (MER) were performed intraoperatively before test-stimulation. The second distal contact of the STN-DBS-electrode was implanted at the stimulation site with the best clinical effect.

In both cases urodynamic investigation under active deep brain stimulation was performed. Both patients were asked to self-assess their subjective micturition function by a questionnaire containing the International Prostate Symptom Score (IPSS) and additional questions on the patient’s medication, prior surgery of the lower urinary tract, and transurethral/suprapubic catheterization in the past. The questionnaire was handed out to assess the patients’ situation immediately prior to as well as 3 days and 3 months after DBS implantation.

Results: Patient No. 1 (DH) had a pre-interventional IPSS of 4 (mild lower urinary tract symptoms, LUTS) and a bother score of 1. Patient No. 2 (ED) showed an IPSS of 8 and a bother score of 2 (mild LUTS) before DBS. Both patients were on no medication for the lower urinary tract, had no history of prior surgery of the prostate and no previous transurethral catheter due to urinary problems. DH and ED developed acute urinary retention after removal of the transurethral catheter. In both cases urodynamic investigation under active DBS revealed atonic detrusor activity. Subvesical obstruction could be excluded by urethro-cystoscopy. A suprapubic catheter had to be inserted for 6 (DH) and 10 weeks (ED). Due to continuous improvement of sensibility and motility of the bladder, 3 months after surgery the IPSS returned to 4+1 (DH) and 8+2 (ED), respectively, in the “stim-on”-condition.

Conclusions: DBS may facilitate suppression of detrusor activity in patients with Parkinson’s disease by influencing central circuitry.