Neurogenic lower urinary tract dysfunction predicts prognosis in patients with multiple system atrophy

Xing, Tianying; Ma, Jinghong; Jia, Chenguang; Ou, Tongwen

doi:10.1007/s10286-020-00678-1

Cited by 12 publications

(14 citation statements)

References 26 publications

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“…Although all MSA patients reported urological symptoms, 8.2% had a normal urodynamic profile. Our data are comparable with those from other MSA studies, that reported percentages with a wide range of urodynamic pattern (detrusor overactivity 34–90%, 8 , 9 , 10 , 11 , 12 , 14 , 20 , 33 , 35 , 36 , 39 , 40 , 41 detrusor sphincter dyssynergia 16–56%, 8 , 10 , 14 , 20 , 35 , 36 , 41 detrusor underactivity 24–88% 8 , 10 , 11 , 12 , 20 , 34 , 36 , 40 ) likely based on different methodical issues. The urodynamic profile between MSA subtypes was basically equivalent with exception of one interesting finding reported in the following.…”

Section: Discussionsupporting

confidence: 91%

“…In this study median detrusor pressure at maximum urinary flow rate was significantly lower and the frequency of detrusor underactivity was significantly higher in MSA-P than MSA-C. These results are also confirmed by recent studies that have shown a more severely impaired bladder contraction in patients with MSA-P compared to MSA-C. 9,11,12 In neurological diseases, urodynamic detected detrusor underactivity reflects involvement of the brainstem, sacral and infrasacral areas. 42 Recently, in a subset of patients presenting initially with urinary retention and only subtle neurological symptoms, urodynamic examination showed detrusor underactivity and an abnormal anal sphincter EMG, suggesting possible onset of disease in the spinal cord.…”

Section: Discussionsupporting

confidence: 89%

“…The evaluation of bladder symptoms might be important in directing diagnosis and therapy. Although several urodynamic studies have been performed in MSA, 8 , 9 , 10 , 11 , 12 , 33 , 35 , 36 , 39 , 40 , 41 , 43 these studies did not analyze the pathophysiology of LUT symptoms. In the interpretation of urodynamic studies it has to be taken into consideration that urodynamic pattern of neurogenic and non‐neurogenic causes might be similar.…”

Section: Discussionmentioning

confidence: 99%

“… 2 , 3 Nonetheless, little is known regarding differences in LUT dysfunction between MSA subtypes and previous studies have reported different results. 8 , 9 , 10 , 11 , 12 In the last decade increasing attention has been paid to urodynamic examination as troublesome urinary symptoms emerge early in disease 3 , 13 , 14 , 15 , 16 prevailing patients to seek urological advice even before emergence of motor symptoms. 17 , 18 …”

mentioning

confidence: 99%

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Urodynamic Evaluation in Multiple System Atrophy: A Retrospective Cohort Study

Eschlböck

Kiss

Krismer

et al. 2021

Movement Disord Clin Pract

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BackgroundBackground: Urological dysfunction in patients with multiple system atrophy (MSA) is one of the main manifestations of autonomic failure. Urodynamic examination is clinically relevant since underlying pathophysiology of lower urinary tract (LUT) dysfunction can be variable. Objective Objective: Evaluation of the pathophysiology of urological symptoms and exploration of differences in urodynamic patterns of LUT dysfunction between MSA-P and MSA-C. Methods Methods: Retrospective study of patients with possible and probable MSA who were referred for urodynamic studies between 2004 and 2019. Demographic data, medical history, physical examination and urodynamic studies assessing storage and voiding dysfunction were obtained. ResultsResults: Seventy-four patients were included in this study (MSA-P 64.9% n = 48; median age 62.5 (IQR 56.8-70) years). Detrusor overactivity during filling phase was noted in 58.1% (n = 43) of the patients. In the voiding phase, detrusor sphincter dyssynergia and detrusor underactivity were observed in 24.6% (n = 17) and in 62.1% (n = 41) of the patients, respectively. A postmicturition residual volume of over 100 ml was present in 71.4% (n = 50) of the patients. Comparison of MSA subtypes showed weaker detrusor contractility in MSA-P compared to MSA-C [pdetQmax 26.2 vs. 34.4 cmH20, P = 0.04]. In 56.2% (n = 41) of patients pathophysiology of LUT dysfunction was deemed to be neurogenic and consistent with the diagnosis of MSA. In 35.6% (n = 26) urodynamic pattern suggested other urological co-morbidities. Conclusion Conclusion:Urodynamic evaluation is an important tool to analyze the pattern of LUT dysfunction in MSA. Impaired detrusor contractility was seen more in MSA-P which needs to be investigated in further studies.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Urodynamic Evaluation in Multiple System Atrophy: A Retrospective Cohort Study

Eschlböck

Kiss

Krismer

et al. 2021

Movement Disord Clin Pract

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“…This study is the first to explore the prognostic value of EAS EMG alterations in MSA. Our results support previous clinical and urodynamic observations, since lower urinary tract symptoms and reduced detrusor contractility were shown to be among the strongest survival predictors in MSA 5‐8,36 . Neurogenic urinary dysfunction was linked to recurrent lower urinary tract infections, a primary cause of death in MSA 37 .…”

Section: Discussionsupporting

confidence: 90%

Diagnostic and Prognostic Value of External Anal SphincterEMGPatterns in Multiple System Atrophy

et al. 2022

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Background It is debated whether external anal sphincter (EAS) electromyography can distinguish between multiple system atrophy (MSA) and Parkinson's disease (PD), whereas its usefulness for MSA prognosis is unknown. Objectives We explored the diagnostic and prognostic value and clinical correlations of EAS electromyography patterns in MSA. Methods We collected clinical data and EAS electromyography findings in 72 patients with MSA and 21 with PD. Results We identified four EAS patterns. The normal pattern was frequently observed in PD and associated with prolonged survival when identified in MSA. Abnormal patterns were predominant in MSA. The most severe pattern was associated with the highest likelihood of MSA diagnosis and with the worst prognosis in the MSA cohort. MSA patients with EAS abnormalities often showed urogenital symptoms and fecal incontinence. Conclusions The increasing severity of EAS electromyography patterns paralleled diagnostic accuracy and survival in MSA, and correlated with prevalence of bladder and bowel symptoms. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

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