Characterization of lower urinary tract symptoms in patients with idiopathic normal pressure hydrocephalus

Abstract

Patients with iNPH present with mild-moderate incontinence of which nocturia is the most common symptom, urge incontinence the most bothersome, with 100% of patients having detrusor overactivity. Younger patients experienced greater bother related to LUTS. To our knowledge, this is the only prospective evaluation of urinary symptoms in patients with new-onset iNPH.

Improvement in lower urinary tract symptoms across multiple domains following ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus

“…Urodynamics testing demonstrated that 100% of iNPH patients had detrusor overactivity. 5 This was in line with findings from prior smaller retrospective studies. 3,8 The mainstay of treatment for iNPH is with ventriculoperitoneal (VP) shunting.…”

“…Responses to validated questionnaires at the initial patient visit were reported previously. 5 All patients with a diagnosis of iNPH underwent provocative testing with lumbar puncture, measurement of opening pressure, and removal of a standard volume of spinal fluid per institution protocol. Patients were observed following this procedure for clinical improvement in iNPH symptoms.…”

“…As previously described, patients presenting to a specialized NPH clinic and who reported any LUTS were considered for enrollment. 5 Patients were evaluated by a group of expert neurosurgeons and neuroscientists, using strict criteria for the diagnosis of Probable iNPH outlined previously. 11,12 Patients who were identified as having new-onset iNPH were then prospectively evaluated by a single attending neuro-urologist with a standardized history and physical.…”

“…7 Our group recently conducted the first prospective study to characterize LUTS in patients with iNPH using a series of validated questionnaires developed by the International Consultation on Incontinence (ICIq). 5 In a cohort of 55 patients with new onset iNPH (prior to surgical intervention for the disease), it was demonstrated that 91% experienced some degree of urinary incontinence at least once per day, with incontinence being urge-predominant. There were several gender-based differences with higher rates of both stress and urge incontinence in women as well as age-based differences with younger patients reporting greater quality of life impact from LUTS.…”

“…3 Several studies have suggested that this may reflect the development of detrusor overactivity, diagnosed urodynamically. [3][4][5] In addition, a major concern for geriatric patients, and specifically for individuals with iNPH, is that LUTS can impact overall functional status 6 and even morbidity and mortality. 7 Our group recently conducted the first prospective study to characterize LUTS in patients with iNPH using a series of validated questionnaires developed by the International Consultation on Incontinence (ICIq).…”