Abstract
Objective: Deep brain stimulation improves motor symptoms and bladder function in Parkinson's disease. Currently there is no evidence of deteriorated bladder function after DBS. We report on two patients who experienced acute transient urinary retention after DBS. Methods: Surgery planning was based on T1 and T2 weighted MRI Images with the patient under general anaesthesia. Multiple microelectrode recordings (MER) were performed intraoperatively in the awake patient before test-stimulation via the macro-tip of the recording electrode. The contact with the widest therapeutic window (low threshold for improvement of akinetic-rigid symptoms and high threshold for stimulation-induced side-effects) was chosen for permanent stimulation via the dbs-electrode. In both cases urodynamic investigation under active deep brain stimulation was performed. Both patients were asked to asses their subjective voiding function by a self administered questionnaire containing the International Prostate Symptom Score (IPSS) and additional questions on patient's medication, prior surgery of the lower urinary tract and transurethral/suprapubic catheterisation in the past. The questionnaire was handed out to assess the patients' situation immediately prior to, 3 days and 3 months after DBS implantation. Results: Patient D.H. had a pre-interventional IPSS of 5 (mild lower urinary tract symptoms (LUTS)). including a bother score of 1. Patient E.D. showed an IPSS of 10 including a bother score of 2 (mild LUTS) before the 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. D.H. and E.D. developed acute urinary retention after removal of the transurethral catheter. In both cases urodynamic investigation under active DBS system revealed atonic detrusor activity, subvesical obstruction could be excluded by urethro-cystoscopy. Due to persistent urinary retention suprapubic catheters had to be inserted in both patients for 6 weeks (D.H.) and 10 weeks (E.D) before they could be removed again with a continuous improvement of sensibility and motility of the bladder. 3 months after the surgery the IPSS returned to a score of 5 (4+1) (D.H.) and 10 (8+2) (E.D.) respectively, in the „stim-ON“ condition. Conclusion: Patients with STN-DBS and normal preoperative bladder function should be monitored for urinary retention. Detrusor atony seems to be a temporary event.
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