Abstract
Purpose
To evaluate whether neurogenic lower urinary tract dysfunction and urodynamic parameters predict the outcomes of patients with multiple system atrophy (MSA).
Methods
A retrospective study was performed in patients who were diagnosed with MSA and underwent urodynamic studies simultaneously from September 2014 to July 2018. The urodynamic traces were reviewed by urologists. Detrusor contractility was evaluated by the bladder contractility index (BCI) and Schäfer nomogram. Telephone follow-up was conducted in July 2019 to acquire survival data. Clinical and urodynamic parameters were analyzed for survival using Cox regression analysis.
Results
Overall, 70 MSA patients were eligible for analysis, and 61 of them underwent urodynamic study within 3 years of initial symptom onset. The parkinsonian subtype of MSA (MSA-P) had a smaller proportion of men as well as longer motor and lower urinary tract symptom durations than the cerebellar subtype (MSA-C). MSA-P also had a lower mean BCI than MSA-C (32.0 ± 27.0 versus 53.6 ± 33.4, p = 0.025). The mean MSA survival time was 5.4 [95% confidence interval (CI) 4.8–6.3] years. Cox regression analysis showed that survival from baseline was correlated only with BCI [hazard ratio (HR) 0.983, 95% CI 0.969–0.997, p = 0.020]. Overall survival was correlated with BCI (HR 0.982, 95% CI 0.966–0.999, p = 0.039) and the presence of urinary incontinence (HR 3.007, 95% CI 0.993–9.220, p = 0.052).
Conclusion
Detrusor contractility can be a prognostic marker in MSA patients. A high BCI value is a protective factor for survival from baseline and overall survival. The presence of urinary incontinence predicts shortened overall survival.
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References
Fanciulli A, Wenning GK (2015) Multiple-system atrophy. N Engl J Med 372(3):249–263
Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, Wood NW, Colosimo C, Durr A, Fowler CJ et al (2008) Second consensus statement on the diagnosis of multiple system atrophy. Neurology 71(9):670–676
Wenning GK, Scherfler C, Granata R, Bosch S, Verny M, Chaudhuri KR, Jellinger K, Poewe W, Litvan I (1999) Time course of symptomatic orthostatic hypotension and urinary incontinence in patients with postmortem confirmed parkinsonian syndromes: a clinicopathological study. J Neurol Neurosurg Psychiatry 67(5):620–623
Low PA, Reich SG, Jankovic J, Shults CW, Stern MB, Novak P, Tanner CM, Gilman S, Marshall FJ, Wooten F et al (2015) Natural history of multiple system atrophy in the USA: a prospective cohort study. Lancet Neurol 14(7):710–719
Wenning GK, Geser F, Krismer F, Seppi K, Duerr S, Boesch S, Kollensperger M, Goebel G, Pfeiffer KP, Barone P et al (2013) The natural history of multiple system atrophy: a prospective European cohort study. Lancet Neurol 12(3):264–274
Coon EA, Sletten DM, Suarez MD, Mandrekar JN, Ahlskog JE, Bower JH, Matsumoto JY, Silber MH, Benarroch EE, Fealey RD et al (2015) Clinical features and autonomic testing predict survival in multiple system atrophy. Brain 138(12):3623–3631
Figueroa JJ, Singer W, Parsaik A, Benarroch EE, Ahlskog JE, Fealey RD, Parisi JE, Sandroni P, Mandrekar J, Iodice V et al (2014) Multiple system atrophy: prognostic indicators of survival. Mov Disord 29(9):1151–1157
Schafer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A, Sterling AM, Zinner NR, van Kerrebroeck P (2002) Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 21(3):261–274
Schafer W (1990) Principles and clinical application of advanced urodynamic analysis of voiding function. Urol Clin North Am 17(3):553–566
Yamamoto T, Sakakibara R, Uchiyama T, Yamaguchi C, Ohno S, Nomura F, Yanagisawa M, Hattori T, Kuwabara S (2014) Time-dependent changes and gender differences in urinary dysfunction in patients with multiple system atrophy. Neurourol Urodyn 33(5):516–523
Kim M, Jung JH, Park J, Son H, Jeong SJ, Oh SJ, Cho SY (2015) Impaired detrusor contractility is the pathognomonic urodynamic finding of multiple system atrophy compared to idiopathic Parkinson’s disease. Parkinsonism Relat Disord 21(3):205–210
Yamamoto T, Asahina M, Yamanaka Y, Uchiyama T, Hirano S, Fuse M, Koga Y, Sakakibara R, Kuwabara S (2017) The utility of post-void residual volume versus sphincter electromyography to distinguish between multiple system atrophy and Parkinson's disease. PLoS ONE 12(1):e0169405
Yamamoto T, Asahina M, Yamanaka Y, Uchiyama T, Hirano S, Fuse M, Koga Y, Sakakibara R, Kuwabara S (2017) Postvoid residual predicts the diagnosis of multiple system atrophy in Parkinsonian syndrome. J Neurol Sci 381:230–234
Gammie A, Kaper M, Dorrepaal C, Kos T, Abrams P (2016) Signs and symptoms of detrusor underactivity: an analysis of clinical presentation and urodynamic tests from a large group of patients undergoing pressure flow studies. Eur Urol 69(2):361–369
Sakakibara R, Hattori T, Uchiyama T, Yamanishi T (2001) Videourodynamic and sphincter motor unit potential analyses in Parkinson’s disease and multiple system atrophy. J Neurol Neurosurg Psychiatry 71(5):600–606
Yamamoto T, Sakakibara R, Uchiyama T, Liu Z, Ito T, Awa Y, Yamamoto K, Kinou M, Yamanishi T, Hattori T (2005) When is Onuf’s nucleus involved in multiple system atrophy? A sphincter electromyography study. J Neurol Neurosurg Psychiatry 76(12):1645–1648
Suhr R, Lahmann NA (2018) Urinary incontinence in home care: a representative multicenter study on prevalence, severity, impact on quality of life, and risk factors. Aging Clin Exp Res 30(6):589–594
Tada M, Onodera O, Tada M, Ozawa T, Piao YS, Kakita A, Takahashi H, Nishizawa M (2007) Early development of autonomic dysfunction may predict poor prognosis in patients with multiple system atrophy. Arch Neurol 64(2):256–260
Watanabe H, Saito Y, Terao S, Ando T, Kachi T, Mukai E, Aiba I, Abe Y, Tamakoshi A, Doyu M et al (2002) Progression and prognosis in multiple system atrophy: an analysis of 230 Japanese patients. Brain 125(Pt 5):1070–1083
Kim HJ, Jeon BS, Lee JY, Yun JY (2011) Survival of Korean patients with multiple system atrophy. Mov Disord 26(5):909–912
Calandra-Buonaura G, Guaraldi P, Sambati L, Lopane G, Cecere A, Barletta G, Provini F, Contin M, Martinelli P, Cortelli P (2013) Multiple system atrophy with prolonged survival: is late onset of dysautonomia the clue? Neurol Sci 34(10):1875–1878
Guevara C, de Grazia J, Baabor P, Soruco W (2019) Self-reported urinary impairment identifies ‘fast progressors’ in terms of neuronal loss in multiple system atrophy. Auton Neurosci 217:1–6
Coon EA, Cutsforth-Gregory JK, Benarroch EE (2018) Neuropathology of autonomic dysfunction in synucleinopathies. Mov Disord 33(3):349–358
Benarroch EE, Schmeichel AM (2001) Depletion of corticotrophin-releasing factor neurons in the pontine micturition area in multiple system atrophy. Ann Neurol 50(5):640–645
Chapple C (2014) Chapter 2: Pathophysiology of neurogenic detrusor overactivity and the symptom complex of “overactive bladder”. Neurourol Urodyn 33(Suppl 3):S6–13
Fowler CJ, Griffiths D, de Groat WC (2008) The neural control of micturition. Nat Rev Neurosci 9(6):453–466
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This study was approved by the Xuanwu Hospital Ethics Committee and performed in accordance with the Declaration of Helsinki.
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Xing, T., Ma, J., Jia, C. et al. Neurogenic lower urinary tract dysfunction predicts prognosis in patients with multiple system atrophy. Clin Auton Res 30, 247–254 (2020). https://doi.org/10.1007/s10286-020-00678-1
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DOI: https://doi.org/10.1007/s10286-020-00678-1