Zhang Lu, Haga Nobuhiro, Ogawa Soichiro, Matsuoka Kanako, Koguchi Tomoyuki, Akaihata Hidenori, Hata Junya, Kataoka Masao, Ishibashi Kei, Kojima Yoshiyuki
Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Department of Urology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China.
Int J Urol. 2017 Nov;24(11):816-819. doi: 10.1111/iju.13432. Epub 2017 Aug 15.
Multiple system atrophy is a neurodegenerative disease that affects autonomic and motor systems. Patients with multiple system atrophy usually experience lower urinary tract symptoms, which sometimes appear as an initial symptom before the emergence of the generalized symptoms. An open bladder neck during the filling phase on video urodynamic study is one characteristic imaging finding after the diagnosis of multiple system atrophy, but has not previously been reported at an early phase of the disease. We report a case in which an open bladder neck was observed on several imaging modalities before generalized symptoms emerged. Because occult neurogenic bladder might exist in patients whose lower urinary tract symptoms are resistant to pharmacotherapy, we report this case to raise awareness of the importance of sufficient imaging evaluations. An open bladder neck might be an important imaging finding for diagnosing multiple system atrophy, irrespective of the presence of generalized symptoms. This finding could help avoid false diagnosis and unnecessary treatment.
多系统萎缩是一种影响自主神经和运动系统的神经退行性疾病。多系统萎缩患者通常会出现下尿路症状，有时这些症状会在全身症状出现之前作为初始症状出现。在视频尿动力学研究中，充盈期膀胱颈开放是多系统萎缩诊断后的一个特征性影像学表现，但此前在疾病早期尚未有报道。我们报告一例在全身症状出现之前，通过多种影像学检查发现膀胱颈开放的病例。由于对药物治疗抵抗的下尿路症状患者可能存在隐匿性神经源性膀胱，我们报告此病例以提高对充分影像学评估重要性的认识。无论是否存在全身症状，膀胱颈开放可能是诊断多系统萎缩的重要影像学表现。这一发现有助于避免误诊和不必要的治疗。
