Eschlböck Sabine, Kiss Gustav, Krismer Florian, Fanciulli Alessandra, Kaindlstorfer Christine, Raccagni Cecilia, Seppi Klaus, Kiechl Stefan, Panicker Jalesh N, Wenning Gregor K
Department of Neurology Medical University of Innsbruck Innsbruck Austria.
Division of Neurourology, Department of Urology Medical University of Innsbruck Innsbruck Austria.
Mov Disord Clin Pract. 2021 Jul 21;8(7):1052-1060. doi: 10.1002/mdc3.13307. eCollection 2021 Oct.
Urological dysfunction in patients with multiple system atrophy (MSA) is one of the main manifestations of autonomic failure. Urodynamic examination is clinically relevant since underlying pathophysiology of lower urinary tract (LUT) dysfunction can be variable.
Evaluation of the pathophysiology of urological symptoms and exploration of differences in urodynamic patterns of LUT dysfunction between MSA-P and MSA-C.
Retrospective study of patients with possible and probable MSA who were referred for urodynamic studies between 2004 and 2019. Demographic data, medical history, physical examination and urodynamic studies assessing storage and voiding dysfunction were obtained.
Seventy-four patients were included in this study (MSA-P 64.9% n = 48; median age 62.5 (IQR 56.8-70) years). Detrusor overactivity during filling phase was noted in 58.1% (n = 43) of the patients. In the voiding phase, detrusor sphincter dyssynergia and detrusor underactivity were observed in 24.6% (n = 17) and in 62.1% (n = 41) of the patients, respectively. A postmicturition residual volume of over 100 ml was present in 71.4% (n = 50) of the patients. Comparison of MSA subtypes showed weaker detrusor contractility in MSA-P compared to MSA-C [pdetQmax 26.2 vs. 34.4 cmH20, = 0.04]. In 56.2% (n = 41) of patients pathophysiology of LUT dysfunction was deemed to be neurogenic and consistent with the diagnosis of MSA. In 35.6% (n = 26) urodynamic pattern suggested other urological co-morbidities.
Urodynamic evaluation is an important tool to analyze the pattern of LUT dysfunction in MSA. Impaired detrusor contractility was seen more in MSA-P which needs to be investigated in further studies.
多系统萎缩（MSA）患者的泌尿功能障碍是自主神经功能衰竭的主要表现之一。尿动力学检查具有临床相关性，因为下尿路（LUT）功能障碍的潜在病理生理学可能各不相同。
评估泌尿症状的病理生理学，并探讨MSA-P和MSA-C之间LUT功能障碍的尿动力学模式差异。
对2004年至2019年间因尿动力学检查而转诊的可能患有和确诊患有MSA的患者进行回顾性研究。获取人口统计学数据、病史、体格检查以及评估储尿和排尿功能障碍的尿动力学研究结果。
本研究纳入了74例患者（MSA-P占64.9%，n = 48；中位年龄62.5岁（四分位间距56.8 - 70岁））。58.1%（n = 43）的患者在充盈期出现逼尿肌过度活动。在排尿期，分别有24.6%（n = 17）和62.1%（n = 41）的患者观察到逼尿肌括约肌协同失调和逼尿肌活动减退。71.4%（n = 50）的患者排尿后残余尿量超过100 ml。MSA亚型比较显示，与MSA-C相比，MSA-P的逼尿肌收缩力较弱[pdetQmax分别为26.2与34.4 cmH2O，P = 0.04]。56.2%（n = 41）的患者LUT功能障碍的病理生理学被认为是神经源性的，与MSA诊断一致。35.6%（n = 26）的尿动力学模式提示存在其他泌尿系统合并症。
尿动力学评估是分析MSA中LUT功能障碍模式的重要工具。MSA-P中逼尿肌收缩力受损更为常见，需要进一步研究。
