Bladder dysfunction (lower urinary tract dysfunction as an initial manifestation of MSA)

Abstract

Multiple system atrophy (MSA) is a neurodegenerative disorder characterized clinically by the combination of autonomic, cerebellar and extrapyramidal dysfunctions. The presence of autonomic dysfunctions is mandatory for the diagnosis of MSA. Some patients showed urinary dysfunctions as an initial manifestation of MSA and it is not uncommon that MSA patients with urinary dysfunction go to the urology department before the neurology department. Our previous study revealed that 18.2–24.0% of MSA patients showed urinary dysfunction as an initial manifestation of MSA. Although urinary dysfunction includes storage and voiding dysfunction, it is common that voiding symptoms such as voiding difficulty are prevalent and severe in the early stage and the disease begins in the sacral cord and then spread to other regions in a subset of MSA patients. Recent study also reported that the presence of urinary dysfunction is important for predicting the prognosis of MSA. It is important to perform detailed examinations of urinary symptoms and measuring post-void residuals for the correct diagnosis of MSA and differentiation of MSA from Parkinson’s disease (PD) in the early stage. We will discuss the clinical characteristics of urinary dysfunction in MSA, the prevalence of MSA patients who initially manifest urinary symptoms, the utility of urinary dysfunction as a prognostic predictor, and the utility of post-void residual in differentiating MSA from PD.