Abstract
In multiple system atrophy (MSA), parkinsonism and a cerebellar syndrome are associated with autonomic dysfunction. Both bladder neck dysfunction and external sphincter denervation have been implicated in detrusor-sphincter dyssynergia. However, urethral dysfunction may not be adequately reflected by a single global measurement of urethral pressure. Pressure assessment at several levels of the urethra is needed to unravel the mechanisms of bladder-urethra dysfunction. Here, we evaluated the use of multiple sensor pressure transducers to assess bladder-sphincter function in 52 patients with MSA in comparison to patients with Parkinson’s disease (PD) who were matched for age and severity in the “off” condition. Urinary dysfunction appeared significantly earlier in MSA (<2 years) than in PD (>5 years). Detrusor under-activity with dysuria was observed in 58% of MSA patients within 4 years and in 76% of patients thereafter. Detrusor-urethral dyssynergia in MSA patients was always better characterized by multiple sensor pressure transducer measurement of bladder and urethral pressure than by a single global measurement. This new approach may prove useful for differential diagnosis of parkinsonian syndromes, and especially MSA.
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References
Wenning GK, Tison F, Ben Shlomo Y, Daniel SE, Quinn NP (1997) Multiple system atrophy: a review of 203 pathologically proved cases. Mov Dis 2:133–147
Gilman S, Low PA, Quinn NP et al (1999) Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci 163:94–98
Stefanova N, Bücke P, Duerr S, Wenning GK (2009) Multiple system atrophy: a update. Lancet Neurol 8:1172–1178
Kirby R, Fowler CJ, Gosling J, Bannister R (1996) Urethro-vesical dysfunction in progressive autonomic failure with multiple system atrophy. J Neurol Neurosurg Psychiatry 49:554–562
Köllensperger M, Stampfer-Kountchev M, Seppi K et al (2007) Progression of dysautonomia in multiple system atrophy: a prospective study of self-perceived impairment. Eur J Neurol 14:66–72
Aranda B, Perrigot M, Mazières L, Pierrot-Deseilligny E (1983) Les troubles vésicosphinctériens de la maladie de Parkinson. Rev Neurol 139:283–288
Winge K, Fowler CJ (2006) Bladder dysfunction in Parkinsonism: mechanisms, prevalence, symptoms, and management. Mov Disord 21:737–745
Sammour ZM, Gomes CM, Barbosa ER et al (2009) Voiding dysfunction in patient with Parkinson’s disease: impact of neurological impairment and clinical parameters. Neurourol Urodyn 28:510–515
Blackett H, Walker R, Wood B (2009) Urinary dysfunction in Parkinson’s disease: a review. Parkinsonism Relat Disord 15:81–87
Beck RO, Betts CD, Fowler CJ (1994) Genitourinary dysfunction in multiple system atrophy: clinical features and treatments in 62 cases. J Urol 151:1336–1341
Bonnet AM, Pichon J, Vidailhet M et al (1997) Urinary disturbances in striatonigral degeneration and Parkinson’s disease; clinical and urodynamic aspects. Mov Disord 12:509–513
Kirchhof K, Apostolidis A, Mathias C, Fowler C (2003) Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a retrospective study. Int J Impot Res 15:293–298
Ito T, Sakakibara R, Yasuda K et al (2006) Incomplete emptying and urina retention in multiple-system atrophy: when does it occur and how do we manage it? Mov Disord 21:816–823
Sakakibara R, Hattori T, Uchiyama T (2001) Videourodynamic and sphincter motor unit potential analyses in Parkinson’s disease and multiple system atrophy. J Neurol Neurosurg Psychiatry 71:600–606
Homma Y, Batista J, Bauer S et al (2002) Urodynamics. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. 2nd International consultation on incontinence, 2nd edn. Health Publication Ltd., Paris, pp 317–372
Abrams P, Cardozo L, Fall M et al (2003) The standardisation of terminology in lower urinary tract dysfunction: report from the standardization sub-committee of the International Continence Society. Urology 61(1):37–49
Yamamoto T, Sakakibara R, Uchiyama T et al (2006) Neurological diseases that cause detrusor hyperactivity with impaired contractile function. Neurourol Urodyn 25:356–360
Schurch B, Yasuda K, Rossier AB (1994) Detrusor bladder neck dyssynergia revisited. J Urol 152:2066–2070
Sakakibara R, Hattori T, Uchiyama T, Kita K, Asahina M, Suzuki A, Yamanishi T (2000) Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation? J Neurol Neurosurg Psychiatry 68:65–69
Wenning GK, Scherfler C, Granata R et al (1999) Time course of symptomatic orthostatic hypotension and urinary incontinence in patients with post-mortem confirmed parkinsonian syndromes: a clinicopathological study. J Neurol Neurosurg Psychiatry 67(5):566
Araki I, Katahara M, Oida T et al (2000) Voiding dysfunction in Parkinson’s disease: urodynamic abnormalities and urinary symptoms. J Urol 164:1640–1643
Hashimoto K, Oyama T, Ukay K et al (1997) Selective destruction of dopamine neurones of the ventral tegmental area, but not the substantia nigra, impairs reflex micturition in rats. Neurourol Urodyn 16:470–471
Acknowledgments
We thank the Centre d’Investigation Clinique (CIC), AP-HP, Université Pierre et Marie Curie-Paris 6, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France. The authors are grateful to Véronique Leteur and David Young for their editorial assistance.
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Bloch, F., Pichon, B., Bonnet, AM. et al. Urodynamic analysis in multiple system atrophy: characterisation of detrusor-sphincter dyssynergia. J Neurol 257, 1986–1991 (2010). https://doi.org/10.1007/s00415-010-5645-x
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DOI: https://doi.org/10.1007/s00415-010-5645-x