Troubles vésicosphinctériens

Le 01/12/2022 de 15:00 à 16:30

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Evaluation urodynamique de la dysurie chez l'homme avec maladie de Parkinson idiopathique

Christophe DANG (Paris, France), Camille CHESNEL (Paris, France), Gabriel MIGET (Paris, France), Maelys TENG (Paris, France), Frédérique LE BRETON (Paris, France), Gérard AMARENCO (Paris, France), Claire HENTZEN (Paris, France)

Objective : Distinction between the impact of Parkinson’s disease (PD) or age-related lower urinary tract disorders such as benign prostatic hypertrophy (BPH) can be a challenge in patients reporting voiding difficulties (VD). This study aimed to describe the causes of VD in men with PD, and to compare the profile of patients function of the etiology of VD.

Material / Patients and Methods : We conducted a retrospective study in men with PD reporting VD, for whom pressure-flow studies were performed. Findings of urodynamics, voiding cystourethrogram (VCUG), and prostatic weight on ultrasonography were retrospectively collected. Urodynamic obstruction and hypocontractility were respectively defined by a Bladder Outlet Obstruction Index >40 and a Bladder Contractility Index <100. Fisher tests and Welch tests were performed to compare patients’ profiles.

Results : Forty-one patients were included (median age 70 (IQR: 66-74)). Twenty-nine (71%) had bladder obstruction. The maximum flow rate was lower (6.8±2.6 ml/s vs 13.6±2.3 ml/s; p<0.001) and the post-void residual was higher in the obstructed group (98.7±132.7ml vs 9.3±16.4ml; p=0.002). Ten patients (24%) had bladder hypocontractility.
Among patients with obstruction, 18 (62%) had BPH and 7 (24%) not. Four patients without BPH and 7 with BPH underwent VCUG: all patients without BPH had a lack of bladder neck opening during micturition compared to only one patient with BPH.

Discussion - Conclusion : VD in patients with PD is more frequently related to bladder outlet obstruction (71%), and BPH is the primary cause. However, other etiologies of VD such as bladder neck obstruction and bladder hypocontractility have to be ruled out.

Keywords : Parkinson's disease ; urodynamics ; voiding difficulties