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Deep brain stimulation effects on lower urinary tract function: Systematic review and meta-analysis.

Elisa Jörg1, Andrea M Sartori2, Anna-Sophie Hofer3

  • 1Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.

Parkinsonism & Related Disorders
|September 5, 2020
PubMed
Summary

Deep brain stimulation (DBS) for neurological disorders does not impair lower urinary tract function and may offer benefits. This finding is crucial for patient counseling during the DBS decision-making process.

Keywords:
Deep brain stimulationMeta-analysisNeuro-urologyNeurogenic lower urinary tract dysfunctionSystematic review

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Area of Science:

  • Neurology
  • Urology
  • Neurosurgery

Background:

  • Deep brain stimulation (DBS) is established for motor symptoms in neurological disorders.
  • Its impact on the autonomic nervous system, specifically lower urinary tract function, is not well understood and remains controversial.

Purpose of the Study:

  • To systematically review and assess the evidence on the effects of DBS on lower urinary tract function.
  • To provide clarity for clinicians and patients regarding potential urinary side effects of DBS.

Main Methods:

  • Systematic review adhering to PRISMA guidelines.
  • Comprehensive literature search across major databases (Cochrane, Embase, Medline, Scopus, Web of Science).
  • Inclusion of 29 studies with 1293 patients.

Main Results:

  • DBS targeting globus pallidus internus (GPi), pedunculopontine nucleus (PPN), and subthalamic nucleus (STN) demonstrated an inhibitory effect on detrusor function.
  • DBS of the ventral intermediate nucleus of the thalamus (VIM) showed an excitatory effect.
  • Meta-analysis indicated DBS of the STN significantly increased maximum bladder capacity (124 mL) without clinically relevant impact on other urodynamic parameters. Adverse events included respiratory issues, postural instability, and dysphagia.

Conclusions:

  • DBS does not negatively affect lower urinary tract function and may even yield beneficial outcomes.
  • These findings should be integrated into the DBS decision-making process to inform and reassure potential patients.
  • Further consideration of DBS's impact on autonomic functions is warranted.