Effects Of Basal Ganglia Surgery

There is very limited information on the effects of basal ganglia surgery on urological dysfunction. The few reports present contradictory results.

Murnaghan reported results of basal ganglia surgery on urological symptoms and urological findings in 29 PD patients. Eight complained of bladder disturbances, and 11 had abnormal cystometrograms. Eleven patients had cystometrograms performed pre- and postoperatively. and only five were unchanged postoperatively. Normal bladder function was converted into hyperreflexic bladder in two out of four patients examined before and after stereo-taxic lesions on the thalamic nuclei, whereas stereotactic lesions of the posterior limb of the internal capsule normalized three out four uninhibited bladders. Murnaghan concluded that thalamotomy may be associated with increased bladder tonus, pallidotomy with decreased bladder tonus and capsulotomy may decrease tonus but bladder sensation may be affected.22

In 1971, Porter and Bors25 also reported on the effects of thalamotomy on bladder function. They studied the effects of uni- and bilateral thalamotomy on 49 patients with PD (11 of whom had normal function). They concluded that neurogenic bladder dysfunction was more frequently seen in bilateral than in unilateral cases. It was only after bilateral stereotaxic surgery that improvement of bladder function could be consistently documented.

The same authors then followed up on the status of 40 patients over a "long term" (4 to 8 months after their last operation, uni- or bilateral). These patients had somatic manifestations that had been "significantly improved" after the surgery (no quantification provided). The results indicated to the authors that the neurogenic bladder of the parkinsonian patient was responsive to surgical therapy, although the response was not as prompt or as successful as the treatment of the somatic manifestations. Furthermore, the subjective response of the individual was often more pronounced than the objective evidence of improvement.

The authors also postulated that thalamotomy improved the post-void residual volume by relaxing the bladder floor and especially in the "hypoactive bladder," by increasing the activity of detrusor muscle.25 This is consistent with the findings of Murnaghan. It would have been of interest to learn if the use of anticholinergics had decreased postoperatively as a possible alternative explanation to decrease in post-void residual.

Andersen et al.4 examined 44 patients with parkin-sonism, including 8 who had undergone thalamotomies. None of the eight patients had normal bladder function. The authors concluded that stereotactic operations on the thalamus could produce uninhibited bladder contractions with subsequent risks of urological disturbances.

To date, there is only one report of effect of basal ganglia surgery on parkinsonian voiding dysfunction stemming from the new era that started in the 1990s.12 The authors studied five patients who had undergone bilateral implantation of subthalamic nucleus electrodes. These patients had not been assessed urologically preopera-tively. Instead, they were studied urodynamically 4 to 9 months after surgery with comparisons made between the stimulator-on and stimulator-off states (no mention made as to being on or off levodopa during the procedures). The authors found consistent improvement in bladder capacity (bladder volume at which urinary leakage was observed or if leakage did not occur, bladder volume at unbearable desire to void) and reflex volume (bladder volume at first hyperreflexic detrusor contraction).


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