Deep brain stimulation effects on lower urinary tract function: Systematic review and meta-analysis.
- Jörg E Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
- Sartori AM Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Institute for Regenerative Medicine, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.
- Hofer AS Institute for Regenerative Medicine, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland; Department of Neurosurgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
- Baumann CR Department of Neurology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
- Kessler TM Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland. Electronic address: tkessler@gmx.ch.
- 2020-09-05
Published in:
- Parkinsonism & related disorders. - 2020
Deep brain stimulation
Meta-analysis
Neuro-urology
Neurogenic lower urinary tract dysfunction
Systematic review
English
INTRODUCTION
While efficacy of deep brain stimulation for motor symptoms of neurological disorders is well accepted, its effects on the autonomic system remain controversial. We aimed to systematically assess all available evidence of deep brain stimulation effects on lower urinary tract function.
METHODS
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by electronic search of Cochrane Central Register of Controlled Trials, Embase, Medline, Scopus, and Web of Science (last search July 12, 2019) and by screening of reference lists and reviews.
RESULTS
After screening 577 articles, we included 29 studies enrolling a total of 1293 patients. Deep brain stimulation of the globus pallidus internus (GPi), pedunculopontine nucleus (PPN), and subthalamic nucleus (STN) had an inhibitory effect on detrusor function, while deep brain stimulation of the ventral intermediate nucleus of the thalamus (VIM) showed an excitatory effect. In the meta-analysis, deep brain stimulation of the STN led to a significant increase in maximum bladder capacity (mean difference 124 mL, 95% confidence interval 60-187 mL, p = 0.0001) but had no clinically relevant effects on other urodynamic parameters. Adverse events (reported in thirteen studies) were most commonly respiratory issues, postural instability, and dysphagia. Risk of bias and confounding was relatively low.
CONCLUSIONS
Deep brain stimulation does not impair lower urinary tract function and might even have beneficial effects. This needs to be considered in the deep brain stimulation decision-making process helping to encourage and to reassure prospective patients.
While efficacy of deep brain stimulation for motor symptoms of neurological disorders is well accepted, its effects on the autonomic system remain controversial. We aimed to systematically assess all available evidence of deep brain stimulation effects on lower urinary tract function.
METHODS
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by electronic search of Cochrane Central Register of Controlled Trials, Embase, Medline, Scopus, and Web of Science (last search July 12, 2019) and by screening of reference lists and reviews.
RESULTS
After screening 577 articles, we included 29 studies enrolling a total of 1293 patients. Deep brain stimulation of the globus pallidus internus (GPi), pedunculopontine nucleus (PPN), and subthalamic nucleus (STN) had an inhibitory effect on detrusor function, while deep brain stimulation of the ventral intermediate nucleus of the thalamus (VIM) showed an excitatory effect. In the meta-analysis, deep brain stimulation of the STN led to a significant increase in maximum bladder capacity (mean difference 124 mL, 95% confidence interval 60-187 mL, p = 0.0001) but had no clinically relevant effects on other urodynamic parameters. Adverse events (reported in thirteen studies) were most commonly respiratory issues, postural instability, and dysphagia. Risk of bias and confounding was relatively low.
CONCLUSIONS
Deep brain stimulation does not impair lower urinary tract function and might even have beneficial effects. This needs to be considered in the deep brain stimulation decision-making process helping to encourage and to reassure prospective patients.
- Language
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- English
- Open access status
- hybrid
- Identifiers
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- DOI 10.1016/j.parkreldis.2020.08.032
- PMID 32889502
- Persistent URL
- https://sonar.ch/global/documents/136333
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