Benign prostatic obstruction and parkinson's disease--should transurethral resection of the prostate be avoided?
OBJECTIVE
According to the literature transurethral resection of the prostate in patients with Parkinson's disease has an increased risk of postoperative urinary incontinence. However, this conclusion might have been reached because some patients with multiple system atrophy incorrectly diagnosed as Parkinson's disease were included in these reports. Therefore, we investigated the outcome of transurethral prostate resection in patients with a secure neurological diagnosis of Parkinson's disease.


METHODS
A total of 23 patients with Parkinson's disease who underwent transurethral prostate resection for benign prostatic obstruction were evaluated retrospectively. Subsequent neurological developments in patients were followed, ensuring that those with multiple system atrophy had not been included in analysis.


RESULTS
At transurethral prostate resection median patient age was 73 years, median duration of Parkinson's disease before the resection was 3 years, and median Hoehn and Yahr scale was 2. Of the 14 patients with a preoperative indwelling urinary catheter transurethral prostate resection restored voiding in 9 (64%) and only 5 (36%) required catheterization postoperatively. Of the 10 patients with preoperative urge urinary incontinence, continence was restored in 5 and improved in 3 following transurethral prostate resection. There were no cases of de novo urinary incontinence after transurethral prostate resection. At a median postoperative followup of 3 years transurethral prostate resection was successful in 16 of the 23 patients (70%).


CONCLUSIONS
Transurethral prostate resection for benign prostatic obstruction in patients with Parkinson's disease may be successful in up to 70% and the risk of de novo urinary incontinence seems minimal. Thus, Parkinson's disease should no longer be considered a contraindication for transurethral prostate resection provided that preoperative investigations including urodynamic assessment indicate prostatic bladder outlet obstruction.
Roth
Beat
B
Department of Urology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, University College London Institute of Neurology, London, United Kingdom.
Studer
Urs E
UE
Fowler
Clare J
CJ
Kessler
Thomas M
TM
D017677:Age Distribution; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000175:diagnosis; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000150:complications* / Q000473:pathology / Q000601:surgery; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000209:etiology; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology / Q000601:surgery