[Is there any obstruction other than prostatic obstruction in Idiopathic Parkinson's Disease?] / Existe-t-il une obstruction autre que prostatique dans la Maladie de Parkinson Idiopathique ?

OBJECTIVE: To highlight the existence of pseudo-dyssynergia in Idiopathic Parkinson's Disease (IPD) constituting a functional bladder outlet obstruction. MATERIALS AND METHODS: A retrospective study was conducted by including men with a confirmed diagnose of IPD who participated in the SIROCCO rehabilitation program. Patients included clinically exhibited overactive bladder and voiding dysfunction without prostatic hypertrophy ultrasounded. They have been clinically assessed by the Urinary Symptoms Profile (USP) urinary symptom score. Bladder outlet obstruction was assessed by the pressure-flow study. Urodynamic obstruction has been quantified by the bladder obstruction index which depends on detrusor pressure at maximum flow rate and maximum flow rate. It has been defined by a BOOI>40. RESULTS: The pressure-flow profile was analyzed in 5 patients who met the inclusion criteria. In this group of 5 patients with IPD, the diagnosis was made on average 10.6 years (7-14) before the pressure-flow studies were performed. Our results objectified 4 patients obstructive among 5 and one equivocal patient. A striated pseudo-dyssynergia was found in the 3 obstructive patients and associated with a smooth pseudodyssynergia in one patient. CONCLUSION: We have observed, in this short series, a pseudo-dyssynergia by subjects suffering from IPD. LEVEL OF EVIDENCE: 3.

[Results and compliance of transcutaneous tibial nerve stimulation on overactive bladder syndrome in patients with Parkinson's disease. Retrospective Study.] / Résultats et observance de la stimulation transcutanée du nerf tibial dans l'hyperactivité vésicale de la maladie de Parkinson idiopathique. Étude rétrospective.

PURPOSE: To investigate efficiency and tolerance of transcutaneous tibial nerve stimulation (TNS) in the overactive bladder syndrome in patients with Parkinson's disease (PD), and to identify predictive factors for compliance. METHODS: We conducted a retrospective monocentric study with a cohort of 17 patients with PD who have used TNS for an overactive bladder syndrome. The efficiency of the treatment was evaluated on the clinical improvement felt (rated out of ten). Patients were classified as « adopters ¼ if they continued using TNS for at least one year after beginning the treatment or as « non adopters ¼ if they stopped. Patients characteristics were evaluated for their predictive value for compliance with TNS. RESULTS: Out of 17 patients, there were 9 women and 8 men, median age 66 years (55-77), median history for Parkinson's disease 8 years (1-22) and for urinary symptoms 3 years (1-10). Subjective efficiency was seen in 10 patients (59%), on nocturia and/or urinary incontinence for 9 patients (mean efficiency 5.75/10 and median efficiency 6.5/10). Three patients found TNS not effective, and four patients didn't use it long enough to evaluate. Two patients had side effects and stopped the TNS (feeling of electricity and restless leg syndrome). 7 patients were classified as « adopters ¼ and 10 patients as « non adopters ¼ after one year. Most evaluated characteristics proved not to be of predictive value for compliance with TNS except nocturia and pollakiuria (P=0.03 and P=0.05). CONCLUSION: Our study seems to reveal TNS is particularly effective on nocturia and urge. Moreover, nocturia and pollakiuria appear to be predictive factors for SNT compliance. Nocturia could be a prominent symptom in SNT's prescription. But studies with more patients should be conducted for obtain better patient selection in TNS. LEVEL OF EVIDENCE: IV.