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Bladder dysfunction as the initial presentation of multiple system atrophy: a prospective cohort study

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Abstract

Objectives

Multiple system atrophy (MSA) is a disease that combines autonomic (orthostatic or bladder) with motor [parkinsonian (MSA-P) or cerebellar (MSA-C)] dysfunction. While bladder dysfunction may occur earlier than motor disorders, thus far no prospective study has been available to determine how often and how early bladder autonomic dysfunction predates motor dysfunction in MSA. Therefore, we present data from detailed history-taking in patients with MSA.

Methods

This is a prospective cohort study. Detailed history-taking was performed and a questionnaire administered in 121 MSA patients (73 MSA-C, 48 MSA-P; 74 men, 47 women; age, 58 ± 8.0 years; initial recruitment period, 5 years; follow-up, 6.5 ± 4.0 years).

Results

Among the patients with MSA-C, 40 patients (55%) suffered motor dysfunction first, 22 (30%) suffered autonomic dysfunction first, and 11 (15%) initially suffered both simultaneously. Among the patients with MSA-P, 22 patients (46%) suffered motor dysfunction first, 22 (46%) suffered autonomic dysfunction first, and two (8%) initially suffered both simultaneously. Among the ‘autonomic-first’ subgroup of MSA-C patients, five suffered orthostatic dysfunction first, 13 suffered urinary dysfunction first, and four initially suffered both simultaneously. Among the ‘autonomic-first’ subgroup of MSA-P patients, six suffered orthostatic dysfunction first, nine suffered urinary dysfunction first, and seven initially suffered both simultaneously. Urinary symptoms were further preceded by erectile dysfunction in men. Overall, 18.2% of patients suffered only urinary symptoms initially, and the mean interval from the onset of urinary to the onset of motor symptoms was 2.8 years (range 1–7 years).

Conclusion

In MSA patients, 18.2% presented with bladder dysfunction as the sole initial manifestation, and the mean interval from the onset of urinary to the onset of motor symptoms was 2.8 years. It is clinically important to avoid unnecessary prostatic surgery when MSA patients see urologists before neurologists.

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Acknowledgements

We cordially thank Prof. Niall Quinn in Queen Square, London for his valuable suggestions.

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Authors and Affiliations

  1. Neurology, Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan

    Ryuji Sakakibara, Fuyuki Tateno, Masahiko Kishi & Yosuke Aiba

  2. Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, UK

    Jalesh Panicker & Sara Simeoni

  3. Continence Center, Dokkyo Medical College, Tochigi, Japan

    Tomoyuki Uchiyama

  4. Neurology, Chiba University, Chiba, Japan

    Tatsuya Yamamoto

  5. Urology, Sakura Medical Center, Toho University, Sakura, Japan

    Ryuji Sakakibara, Jalesh Panicker, Sara Simeoni, Tomoyuki Uchiyama, Tatsuya Yamamoto, Fuyuki Tateno, Masahiko Kishi & Yosuke Aiba

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  1. Ryuji Sakakibara
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  2. Jalesh Panicker
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Correspondence to Ryuji Sakakibara.

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Sakakibara, R., Panicker, J., Simeoni, S. et al. Bladder dysfunction as the initial presentation of multiple system atrophy: a prospective cohort study. Clin Auton Res 29, 627–631 (2019). https://doi.org/10.1007/s10286-018-0550-y

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  • DOI: https://doi.org/10.1007/s10286-018-0550-y

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