1College of Medicine, University of Florida.
2Lillian S. Wells Department of Neurosurgery, University of Florida; and.
J Neurosurg. 2024 Feb 2;141(1):221-229. doi: 10.3171/2023.11.JNS231668. Print 2024 Jul 1.
Deep brain stimulation (DBS) is a common procedure in neurosurgery used for the treatment of Parkinson's disease (PD) and essential tremor (ET) among other disorders. Lower urinary tract dysfunction is a common complication in PD, and this study aimed to evaluate the risk factors of postoperative urinary retention (POUR) after DBS surgery in patients with PD compared with patients with ET. Understanding the risk factors associated with this complication may help in the development of strategies to minimize its occurrence and improve patient outcomes.
The study was a retrospective analysis of patients who underwent DBS surgery for PD and ET at the University of Florida between 2010 and 2021. The surgical technique used has been described in previous articles and included a two-stage procedure, with stage 1 involving burr hole placement, microelectrode recording, and electrode implantation and stage 2 involving the placement of an implantable pulse generator (IPG). Data were collected on patient characteristics and surgical details and analyzed using univariate and mixed-linear models. Post hoc propensity score matching was used to confirm the association between subthalamic nucleus (STN)-DBS and POUR.
The study included 350 patients (153 with PD and 197 with ET) who underwent 1086 DBS surgeries (lead implantations, IPG placement, and IPG replacements). The POUR rates were 16.6% (79/477), 5.2% (19/363), and 0.4% (1/246) for stage 1, stage 2, and IPG replacement procedures, respectively. Optimal mixed-effects logistic modeling revealed history of urinary retention (OR 9.3, p = 0.004), male sex (OR 2.7, p = 0.011), having an electrode placed or connected for the first time (OR 2.2, p = 0.014), anesthesia time (OR 1.5 for each 30-minute increase, p < 0.0001), preoperative opioid use (OR 1.4 for each additional 10 morphine milligram equivalents, p = 0.032), and Charlson Comorbidity Index (OR 1.4 per comorbidity, p = 0.017) to be significant risk factors for POUR. Having an electrode in the STN was found to be protective of POUR (propensity score-matched analysis: OR 0.2, p = 0.010).
Most risk factors found to increase the risk of POUR in DBS are not modifiable but are still important to consider in preoperative planning. Opioid use reduction and shorter anesthesia time may be modifiable risk factors to weigh against their alternative. Targeting the STN during DBS may result in decreased rates of POUR. This highlights the potential for STN-targeted DBS in reducing POUR risk in PD and ET patients.
深部脑刺激（DBS）是神经外科中常用的一种手术，用于治疗帕金森病（PD）和原发性震颤（ET）等疾病。下尿路功能障碍是 PD 的常见并发症，本研究旨在评估 PD 患者与 ET 患者相比，DBS 手术后发生术后尿潴留（POUR）的风险因素。了解与该并发症相关的风险因素可能有助于制定策略，以最大程度地减少其发生并改善患者预后。
本研究是对 2010 年至 2021 年期间在佛罗里达大学接受 PD 和 ET 行 DBS 手术的患者进行的回顾性分析。所使用的手术技术已在先前的文章中进行了描述，包括两阶段手术，第一阶段包括颅骨钻孔、微电极记录和电极植入，第二阶段包括植入式脉冲发生器（IPG）的放置。收集患者特征和手术细节的数据，并使用单变量和混合线性模型进行分析。事后倾向评分匹配用于确认底丘脑核（STN）-DBS 与 POUR 之间的关联。
该研究纳入了 350 名患者（153 名 PD 患者和 197 名 ET 患者），共进行了 1086 次 DBS 手术（导联植入、IPG 放置和 IPG 更换）。STN-DBS 治疗原发性震颤患者术后发生尿潴留的比例为 0.4%（1/246）。
大多数增加 DBS 后发生 POUR 风险的因素是不可改变的，但在术前计划中仍需考虑。减少阿片类药物的使用和缩短麻醉时间可能是需要权衡的可改变的风险因素。在 DBS 中靶向 STN 可能会降低 POUR 的发生率。这突出了 STN 靶向 DBS 在降低 PD 和 ET 患者 POUR 风险方面的潜力。
