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

Abstract

Surgical intervention for iNPH results in significant improvement in urinary symptoms, specifically in terms of urinary urgency and urge incontinence as well as overall quality of life, particularly in women and younger patients.

5-Year health-related quality of life outcome in patients with idiopathic normal pressure hydrocephalus

“…The Cox Proportional-Hazards Model was conducted for mortality analysis. The variable selection of statistical models was based on clinical significance and previously established predictors (Table 1) [1][2][3][4][5][6][7]. Due to drop-out/missing data, additional steps to detect signs of attrition bias were taken: when all variables (including outcome indicators) were analyzed at the same time to detect systematic tendencies in missing data, no significant tendencies were observed (Little's Missing Completely at Random-test; p = 0.067).…”

“…Seven studies have evaluated health-related quality of life (HRQoL) in patients with idiopathic normal pressure hydrocephalus (iNPH) prior to and after cerebrospinal fluid (CSF) shunting (Table 1) [1][2][3][4][5][6][7]. A significant heterogeneity exists among the published studies: six different HRQoL instruments were applied, follow-up times ranged from 3 to 45 months and there was a lack of studies replicating and confirming previous findings (Table 1) [1][2][3][4][5][6][7].…”

“…Seven studies have evaluated health-related quality of life (HRQoL) in patients with idiopathic normal pressure hydrocephalus (iNPH) prior to and after cerebrospinal fluid (CSF) shunting (Table 1) [1][2][3][4][5][6][7]. A significant heterogeneity exists among the published studies: six different HRQoL instruments were applied, follow-up times ranged from 3 to 45 months and there was a lack of studies replicating and confirming previous findings (Table 1) [1][2][3][4][5][6][7]. Factors associated with poorer HRQoL outcome in iNPH in uni-or multivariate analyses have been identified: depressive symptoms [2], larger comorbidity burden [2,4,6], obesity [4], hyperlipidemia [2], severity of gait impairment [2], post-operative complications [5] and beta amyloid (Aβ) or hyperphosphorylated tau (HPτ) pathology in the frontal cortical biopsy [4].…”

“…Factors associated with poorer HRQoL outcome in iNPH in uni-or multivariate analyses have been identified: depressive symptoms [2], larger comorbidity burden [2,4,6], obesity [4], hyperlipidemia [2], severity of gait impairment [2], post-operative complications [5] and beta amyloid (Aβ) or hyperphosphorylated tau (HPτ) pathology in the frontal cortical biopsy [4]. While five out of seven (71%) studies observed significant HRQoL improvement following CSF shunting, only three studies reported HRQoL improvement rates [2,4,5], that ranged from 43 to 83% (Table 1) [1][2][3][4][5][6][7]. These three studies were also the only ones having controls from the general population, two of which compared HRQoL between their cohort and controls [2,5].…”

“…These three studies were also the only ones having controls from the general population, two of which compared HRQoL between their cohort and controls [2,5]. When it comes to improvement of limited dimensions of HRQoL, gender (female) has been associated with greater improvement in mental health [6] and urinary symptoms [3] following surgery. While persons with iNPH having post-operative complications are justifiably thought to report lower HRQoL [4][5][6]8], only one study has shown difference in HRQoL to those without any complications [5].…”