Time-dependent changes and gender differences in urinary dysfunction in patients with multiple system atrophy

Yamamoto, Tatsuya; Sakakibara, Ryuji; Uchiyama, Tomoyuki; Yamaguchi, Chiharu; Ohno, Sayaka; Nomura, Fumio; Yanagisawa, Mitsuru; Hattori, Takamichi; Kuwabara, Satoshi

doi:10.1002/nau.22441

Cited by 23 publications

(29 citation statements)

References 14 publications

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“…Sex differences were not statistically significant in this study. Although we previously reported several papers regarding the lower urinary tract dysfunction of PD and MSA using a urodynamic study and an anal sphincter EMG [1–3], the present study advanced the direct statistical comparison between the PVR and the anal sphincter EMG, which has not been previously reported.…”

Section: Discussionmentioning

confidence: 70%

“…All patients who experienced any lower urinary tract symptoms were assessed by a detailed urinary symptom questionnaire [1,3]. Patients with MSA were diagnosed with probable or possible MSA based on the Gilman et al [14] second consensus criteria.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, multiple studies (including our previous studies) suggested that the PVR of patients with MSA was significantly larger than that of patients with PD [1,3,12]. However, the optimal parameters for differentiating MSA from PD remain unknown.…”

Section: Introductionmentioning

confidence: 99%

“…Although it is often difficult to differentiate multiple system atrophy (MSA) from Parkinson’s disease (PD), examining urinary dysfunction might be helpful for diagnosing MSA in cases with more severe urinary voiding dysfunction than in PD [1–3]. We previously reported that the post-void residual urine volume (PVR) and sphincter electromyography (EMG) might be helpful for differentiating MSA from PD [1–4].…”

Section: Introductionmentioning

confidence: 99%

“…We previously reported that the post-void residual urine volume (PVR) and sphincter electromyography (EMG) might be helpful for differentiating MSA from PD [1–4]. Urinary voiding dysfunctions are examined by a urinary symptom questionnaire and measuring the PVR in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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The Utility of Post-Void Residual Volume versus Sphincter Electromyography to Distinguish between Multiple System Atrophy and Parkinson’s Disease

et al. 2017

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ObjectiveTo determine the ability of sphincter electromyography (EMG) and post-void residual urine volume (PVR) during a free-flow study and a pressure-flow study (PFS) for distinguishing multiple system atrophy (MSA) from Parkinson’s disease (PD).MethodsWe retrospectively reviewed 241 case records; both urodynamic study and sphincter EMG were performed in patients with MSA (n = 147) and PD (n = 94).ResultsThere was a statistically significant difference (p < 0.01) in the mean PVR during the free-flow study (113.1 ± 7.5 mL in MSA and 40.4 ± 3.8 mL in PD), mean PVR during PFS (230.1 ± 12.6 mL in MSA and 71.7 ± 6.6 mL in PD), and mean duration of MUP for sphincter EMG (9.3 ± 0.1 ms in MSA and 7.7 ± 0.1 ms in PD). The area under the curve used for differentiating MSA from PD was 0.79 and 0.73 for PVR during PFS and the free-flow study, respectively. There was a mean duration of 0.69 ms for the sphincter EMG.ConclusionsThe present results suggested that PVR was more appropriate than sphincter EMG for differentiating MSA from PD.

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Section: Discussionmentioning

confidence: 70%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Utility of Post-Void Residual Volume versus Sphincter Electromyography to Distinguish between Multiple System Atrophy and Parkinson’s Disease

et al. 2017

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Urinary Dysfunctions Are More Severe in the Parkinsonian Phenotype of Multiple System Atrophy

Yamamoto

Asahina

Yamanaka

et al. 2016

Movement Disord Clin Pract

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Background MSA is clinically classified into two phenotypes: parkinsonism predominant (MSA‐P) and cerebellar ataxia predominant (MSA‐C). However, little is known about the differences in urinary dysfunctions between MSA‐C and MSA‐P. We investigated the differences in urinary and cardiovascular dysfunctions between MSA‐C and MSA‐P. Methods We retrospectively reviewed the medical records of patients with MSA diagnosed as having probable or possible MSA according to Gilman's second consensus criteria from January 2007 to September 2013 in our hospital. Data regarding the initial symptoms, onset of urinary symptoms, and results of urodynamic (including anal sphincter electromyography) and head‐up tilt tests were collected. Results A total of 100 patients with MSA, including 59 patients with MSA‐C and 41 with MSA‐P, were reviewed. Initial symptoms were autonomic (n = 12) and cerebellar (n = 47) in the MSA‐C phenotype and were autonomic (n = 14) and parkinsonian (n = 27) in the MSA‐P phenotypes. Urodynamic study indicated that bladder contraction was more severely impaired in patients with MSA‐P than in those with MSA‐C. In the head‐up tilt test, the decrease in diastolic blood pressure was significantly larger in the MSA‐P phenotype than that in the MSA‐C phenotype. Acontractile bladder during the pressure flow study increased likelihood that the phenotype is MSA‐P (odds ratio: 6.67; 95% confidence interval: 1.004–44.284; P = 0.050). Conclusions Urinary dysfunctions were more severe in MSA‐P compared with MSA‐C. Detailed urodynamic study was helpful for detecting subtle differences between MSA‐C and MSA‐P.

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Detrusor underactivity in women: A current understanding

Hartigan

Reynolds

Dmochowski

2019

Neurourology and Urodynamics

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Aims To examine the current understanding and management of detrusor underactivity (DUA) and underactive bladder (UAB) in women. Methods A review of the current literature was performed with a specific focus on new management strategies and treatment options for women with DUA and UAB. Results DUA has become an area of increased interest in recent years. Affecting up to 45% of older women undergoing urodynamic evaluation for non‐neurogenic lower urinary tract symptoms, DUA is common. There are a variety of possible etiologies including neurogenic or myogenic dysfunction. As there is currently no cure for DUA and no way to restore the ability of the detrusor muscle to contract, management of DUA in women is mostly focused on effective bladder drainage by urinary catheterization. Clean intermittent catheterization is the gold standard for bladder drainage however for a variety of reasons, women with DUA often are managed with indwelling urethral catheter or suprapubic tube. Medications, sacral neuromodulation, and the inFlow urinary prosthesis are also treatment alternatives or additions to catheterization. Novel therapies using stem cells and gene therapy are also under investigation for the treatment of DUA and UAB. Conclusions DUA is likely more prevalent than recognized and undertreated in women. It is vital that further research in treatment options beyond catheterization be developed for these patients to offer patients a variety of treatment options.

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Time-dependent changes and gender differences in urinary dysfunction in patients with multiple system atrophy

Cited by 23 publications

References 14 publications

The Utility of Post-Void Residual Volume versus Sphincter Electromyography to Distinguish between Multiple System Atrophy and Parkinson’s Disease

The Utility of Post-Void Residual Volume versus Sphincter Electromyography to Distinguish between Multiple System Atrophy and Parkinson’s Disease

Urinary Dysfunctions Are More Severe in the Parkinsonian Phenotype of Multiple System Atrophy

Detrusor underactivity in women: A current understanding

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