Clinical Autonomic Research

, Volume 29, Issue 6, pp 627–631 | Cite as

Bladder dysfunction as the initial presentation of multiple system atrophy: a prospective cohort study

  • Ryuji SakakibaraEmail author
  • Jalesh Panicker
  • Sara Simeoni
  • Tomoyuki Uchiyama
  • Tatsuya Yamamoto
  • Fuyuki Tateno
  • Masahiko Kishi
  • Yosuke Aiba
Research Article



Multiple system atrophy (MSA) is a disease that combines autonomic (orthostatic or bladder) with motor [parkinsonian (MSA-P) or cerebellar (MSA-C)] dysfunction. While bladder dysfunction may occur earlier than motor disorders, thus far no prospective study has been available to determine how often and how early bladder autonomic dysfunction predates motor dysfunction in MSA. Therefore, we present data from detailed history-taking in patients with MSA.


This is a prospective cohort study. Detailed history-taking was performed and a questionnaire administered in 121 MSA patients (73 MSA-C, 48 MSA-P; 74 men, 47 women; age, 58 ± 8.0 years; initial recruitment period, 5 years; follow-up, 6.5 ± 4.0 years).


Among the patients with MSA-C, 40 patients (55%) suffered motor dysfunction first, 22 (30%) suffered autonomic dysfunction first, and 11 (15%) initially suffered both simultaneously. Among the patients with MSA-P, 22 patients (46%) suffered motor dysfunction first, 22 (46%) suffered autonomic dysfunction first, and two (8%) initially suffered both simultaneously. Among the ‘autonomic-first’ subgroup of MSA-C patients, five suffered orthostatic dysfunction first, 13 suffered urinary dysfunction first, and four initially suffered both simultaneously. Among the ‘autonomic-first’ subgroup of MSA-P patients, six suffered orthostatic dysfunction first, nine suffered urinary dysfunction first, and seven initially suffered both simultaneously. Urinary symptoms were further preceded by erectile dysfunction in men. Overall, 18.2% of patients suffered only urinary symptoms initially, and the mean interval from the onset of urinary to the onset of motor symptoms was 2.8 years (range 1–7 years).


In MSA patients, 18.2% presented with bladder dysfunction as the sole initial manifestation, and the mean interval from the onset of urinary to the onset of motor symptoms was 2.8 years. It is clinically important to avoid unnecessary prostatic surgery when MSA patients see urologists before neurologists.


Multiple system atrophy Autonomic dysfunction Urinary dysfunction Prostatic hypertrophy Nonmotor signs 



We cordially thank Prof. Niall Quinn in Queen Square, London for his valuable suggestions.

Compliance with ethical standards

Conflict of interest

We have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Neurology, Internal Medicine, Sakura Medical CenterToho UniversitySakuraJapan
  2. 2.Uro-NeurologyThe National Hospital for Neurology and Neurosurgery and UCL Institute of NeurologyLondonUK
  3. 3.Continence CenterDokkyo Medical CollegeTochigiJapan
  4. 4.NeurologyChiba UniversityChibaJapan
  5. 5.Urology, Sakura Medical CenterToho UniversitySakuraJapan

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