Abstract
Introduction:Lower urinary tract symptoms (LUTS) are under-appreciated in Parkinson’s disease (PD), however are important
symptoms. This thesis undertakes a package of work to improve the assessment and management of LUTS in PD.
This comprises an observational study on LUTS prevalence in a representative PD group, followed by a RCT of
transcutaneous tibial nerve stimulation (TTNS) for urinary urgency. This concludes with an observational study of
the prevalence of nocturnal polyuria in PD.
Methods:
Prevalence data on LUTS was calculated based on pre-existing data from the PRME-UK cross-sectional study,
which included the ICIQ male and female LUTS questionnaire.
A randomised control trial named STRIPE was implemented, comprising an intervention of TTNS performed at
home by participants using the Geko™ device, versus sham comparator. The primary outcome was ICIQ-OAB
score at 12 weeks.
The nocturnal polyuria (NP) study used 72-hour bladder diaries from STRIPE. Nocturnal polyuria index (NPi) and
hourly nocturnal urine production (NUP) were calculated.
Results:
83.3% of participants in PRIME-UK had at least one LUTS. The most common was nocturia (64.7%). Urinary
urgency affected 46.7% and incontinence 44.7%.
148 participants were enrolled in STRIPE. This thesis is based on a penultimate data-cut (2 participants remain).
No significant difference existed between active and sham arms for ICIQ-OAB scores at 12 weeks, although both
demonstrated mean clinically meaningful improvements over baseline.
176 72-hour bladder diaries were collected. 62.6% had NP based on the NPi33 threshold and 39.1% for NUP90. A
significant association was demonstrated between number of night-time voids and extent of NP.
Conclusions:
The cross-sectional data demonstrated LUTS are extremely common. The outcome of STRIPE suggests active TTNS
does not provide benefit over sham stimulation, although fits ongoing challenges in developing sham paradigms
for neuromodulation studies. NP is a common factor in causing nocturia, linked to greater burden of nocturia.
| Date of Award | 19 Mar 2024 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | Emily J Henderson (Supervisor) & Yoav Ben-Shlomo (Supervisor) |