Parkinson's Disease (PD) is the second-most common degenerative neurologic disease worldwide. Up to 85% of these patients suffer from bothersome lower urinary tract symptoms (LUTS), including overactive bladder (OAB). Sacral Neuromodulation (SNM) and intradetrusor onabotulinumA toxin (BoNTA) injections are two prevalent third-line interventions, yet their comparative efficacy in PD patients remains under-explored.
Methods:
Aretrospective review of PD patients who failed or did not tolerate medical management and underwent SNM or BoNTA from 2000-2022 was performed. Patient demographics, baseline LUTS, and adverse events were recorded. Primary outcomes included percentage improvement in LUTS and adverse events.
Results:
100 patients were included in the final cohort, 45 of whom underwent SNM and 55 who received BoNTA injections. Baseline demographics were comparable between the two groups, with no significant differences in age, sex, Charlson Comorbidity Index (CCI), and various clinical symptoms, including baseline LUTS (OAB, urge/stress/mixed urinary incontinence, acute urinary retention). 82.2% of the SNM group experienced a greater than 50% improvement in symptoms compared to 63.6% in the BoNTA group (p[0.0462). While the BoNTA group had a higher incidence of postprocedural urinary retention (12.73% vs. 0%, p[0.0155), 6 of these 7 patients had pre-existing urinary retention. No significant differences were observed in urinary tract infections between the groups (2.22% vs. 7.27%, p[0.3751).
Conclusions:
Both SNM and BoNTA injections provide significant relief for LUTS in PD patients; however, SNM may yield a higher percentage of symptom improvement when compared to BoNTA injections. Both third-line options were well tolerated within this cohort with no differences in adverse events.
