Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Report
  • Published:

Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a retrospective study

International Journal of Impotence Research volume 15, pages 293–298 (2003)Cite this article

Abstract

Multiple system atrophy (MSA) is a progressive neurodegenerative disease characterized by parkinsonism and cerebellar, autonomic, urinary, and/or pyramidal dysfunction. Urinary and erectile dysfunction (ED) symptoms are prominent early features in men with MSA. Autonomic failure, considered until recently to be the cause of ED in these men, is commonly expressed through symptoms of orthostatic hypotension (OH). The aim of this retrospective study is to examine the chronological relationship between the development of urogenital symptoms and those of OH in patients diagnosed with MSA and discuss its significance in the aetiology of ED in these patients. A total of 71 male patients, referred to a Uro-Neurology department with a diagnosis of ‘probable MSA’, were reviewed in terms of ‘autonomic’ symptoms only—OH and lower urinary tract symptoms, accompanied by ED—present at the time of their referral. Laboratory investigations including anal sphincter EMG and/or autonomic function tests (AFTs) were performed in 75 and 90% of the patients, respectively. At presentation, urinary complaints were recorded in 96% of patients and ED in all patients that this was inquired about. The onset of ED had preceded the onset of bladder symptoms in 58% and the onset of OH symptoms in 91% of these men. Bladder symptoms also preceded symptoms of OH in 76% of patients. Sphincter EMG was abnormal in 91% and AFTs in 77% of the patients tested. Almost all patients with abnormal EMG had troublesome urinary symptoms. AFTs showed similar sensitivity relating to symptoms. At presentation, urogenital symptoms are common in patients with probable MSA and are often not accompanied by symptoms of OH. The earlier occurrence of ED in men with MSA suggests a lack of a causal relationship to hypotension. The notion that MSA possibly affects the dopaminergic mechanism of erectile function is discussed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Wenning G et al. Clinical features and natural history of multiple system atrophy. Brain 1994; 117: 835–845.

    Article  Google Scholar 

  2. Wermuth L, Joensen P, Bunger N, Jeune B . High prevelence of Parkinson's disease in the Feroe islands. Neurology 1997; 49: 426–432.

    Article  CAS  Google Scholar 

  3. Chio A, Magnani C, Schiffer D . Prevalence of Parkinson's disease in Northwestern Italy: comparison of tracer methodology and clinical ascertainment of cases. Mov Disord 1998; 13: 400–405.

    Article  CAS  Google Scholar 

  4. Schrag A, Ben-Shlomo Y, Quinn N . Prevalence of progressive supranuclear palsy and multiple system atrophy: a cross-sectional study. Lancet 1999; 354: 1771–1775.

    Article  CAS  Google Scholar 

  5. Bower JH, Maraganore DM, McDonnell SK, Rocca WA . Incidence of progressive supranuclear pulsy and multiple system atrophy in Olmsted County, Minnesota, 1976 to 1990. Neurology 1997; 49: 1284–1288.

    Article  CAS  Google Scholar 

  6. de Rijk MC et al. Prevalence of Parkinson's disease in the elderly: the Rotterdam study. Neurology 1995; 45: 2143–2146.

    Article  CAS  Google Scholar 

  7. Klockgether T et al. The natural history of degenerative ataxia: a retrospective study in 466 patients. Brain 1998; 121: 589–600.

    Article  Google Scholar 

  8. Mathias CJ, Mallipeddi R, Bleasdale-Barr K . Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy. J Neurol Sci 1999; 246: 893–898.

    Article  CAS  Google Scholar 

  9. Shannon JR et al. The hypertension of autonomic failure and its treatment. Hypertension 1997; 30: 1062–1067.

    Article  CAS  Google Scholar 

  10. Muldowney III JAS et al. Orthostatic heart rate changes in multiple system atrophy. Clin Auton Res 1998; 8: 269.

    Google Scholar 

  11. Kirby R, Fowler CJ, Gosling J, Bannister R . Urethro-vesical dysfunction in progressive autonomic failure with multiple system atrophy. J Neurol Neurosurg Psychiatry 1986; 49: 554–562.

    Article  CAS  Google Scholar 

  12. Pullen A, Tucker D, Martin J . Morphological and morphometric characterization of Onuf's nucleus in the spinal cord in man. J Anat 1997; 191: 201–213.

    Article  Google Scholar 

  13. Sung JH, Mastri AR, Segal E . Pathology of the Shy–Drager syndrome. J Neuropath Exp Neurol 1978; 38: 253–268.

    Google Scholar 

  14. Pramstaller PP et al. Nerve conduction studies, skeletal muscle EMG, and sphincter EMG in multiple system atrophy. J Neurol Neurosurg Psychiatry 1995; 58: 618–621.

    Article  CAS  Google Scholar 

  15. Rodi Z, Denislic M, Vodusek D . External anal sphincter electromyography in the differential diagnosis of parkinsonism. J Neurol Neurosurg Psychiatry 1996; 60: 460–461.

    Article  CAS  Google Scholar 

  16. Sakuta M, Nakanishi T, Toyokura Y . Anal muscle electromyograms differ in amyotrophic lateral sclerosis and Shy–Drager syndrome. Neurology 1978; 28: 1289–1293.

    Article  CAS  Google Scholar 

  17. Berger Y, Salinas JM, Blaivas J . Urodynamic differentiation of Parkinson's disease and the Shy–Drager syndrome. Neurourol Urodyn 1990; 9: 117–121.

    Article  Google Scholar 

  18. Stocchi F et al. Urodynamic and neurophysiological evaluation in Parkinson's disease and multiple system atrophy. J Neurol Neurosurg Psychiatry 1997; 62: 507–511.

    Article  CAS  Google Scholar 

  19. Vodusek D . Sphincter EMG and differential diagnosis of multiple system atrophy. Mov Disord 2001; 16: 600–607.

    Article  CAS  Google Scholar 

  20. Palace J, Chandiramani VA, Fowler CJ . Value of sphincter EMG in the diagnosis of multiple system atrophy. Muscle Nerve 1997; 20: 1396–1403.

    Article  CAS  Google Scholar 

  21. Feldman H et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

    Article  CAS  Google Scholar 

  22. Sakakibara R et al. Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation? J Neurol Neurosurg Psychiatry 2000; 68: 65–69.

    Article  CAS  Google Scholar 

  23. Gilman S et al. Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci 1999; 163: 94–98.

    Article  CAS  Google Scholar 

  24. Beck RO, Betts CD, Fowler CJ . Genito-urinary dysfunction in multiple system atrophy: clinical features and treatment in 62 cases. J Urol 1994; 151: 1336–1341.

    Article  CAS  Google Scholar 

  25. Mathias CJ, Bannister R . Investigation of autonomic disorders. In: Mathias CJ, Bannister R (eds). Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System. Oxford University Press: Oxford, 1999, pp 169–195.

    Google Scholar 

  26. Hussain I et al. Treatment with sildenafil citrate (Viagra) of erectile dysfunction in parkinsonism due to parkinson's disease or multiple system atrophy and the risk of exacerbating orthostatic hypotension. J Neurol Neurosurg Psychiatry 2001; 71: 371–374.

    Article  CAS  Google Scholar 

  27. de Groat WC, Booth AM . Neural control of penile erection. In: Maggi CA (ed). The Autonomic Nervous System. Nervous Control of the Urogenital System. Harwood: London, 1993, pp 465–513.

    Google Scholar 

  28. Hoyle CHV, Lincoln J, Burnstock G . Neural control of pelvic organs. In: Rushton DN (ed). Handbook of Neuro-Urology. Marcel Dekker: New York, 1994, pp 1–54.

  29. Andersson K-E . Neurophysiology/pharmacology of erection. Int J Impot Res 2001; 13: S8–S17.

    Article  Google Scholar 

  30. Heaton J . Central neuropharmacological agents and mechanisms in erectile dysfunction: the role of dopamine. Neurosci Behav Revi 2000; 24: 561–569.

    Article  CAS  Google Scholar 

  31. Uitti R et al. Hypersexuality with antiparkinsonian therapy. Clin Neuropharmacol 1989; 12: 375–383.

    Article  CAS  Google Scholar 

  32. Courty E . Psychiatric and sexual disorders induced by apomorphine in Parkinson's disease. Clin Neuropharmacol 1997; 20: 140–147.

    Article  CAS  Google Scholar 

  33. O'Sullivan J, Hughes A . Apomorphine-induced penile erections in Parkinson's disease. Mov Disord 1998; 13: 536–539.

    Article  CAS  Google Scholar 

  34. Chandiramani VA, Palace J, Fowler CJ . How to recognise patients with parkinsonism who should not have urological surgery. Br J Urol 1997; 80: 100–104.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Division of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany

    K Kirchhof

  2. Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK

    AN Apostolidis & CJ Fowler

  3. Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK

    CJ Mathias

Authors
  1. K Kirchhof
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. AN Apostolidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. CJ Mathias
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. CJ Fowler
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kirchhof, K., Apostolidis, A., Mathias, C. et al. Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a retrospective study. Int J Impot Res 15, 293–298 (2003). https://doi.org/10.1038/sj.ijir.3901014

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijir.3901014

Keywords

This article is cited by

Search

Advanced search

Quick links