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Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a
K Kirchhof1, A N Apostolidis, C J Mathias
1Department of Neurology, Division of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.
International Journal of Impotence Research
|August 23, 2003
Summary
In men with Multiple System Atrophy (MSA), erectile dysfunction (ED) and bladder issues often appear before orthostatic hypotension (OH). This suggests ED in MSA may not stem from autonomic failure alone.
Area of Science:
- Neuroscience
- Urology
- Neurology
Background:
- Multiple system atrophy (MSA) is a progressive neurodegenerative disorder.
- Early symptoms in men with MSA often include urinary and erectile dysfunction (ED).
- Autonomic failure, specifically orthostatic hypotension (OH), was previously thought to cause ED in MSA.
Purpose of the Study:
- To investigate the chronological relationship between urogenital symptoms and OH in MSA patients.
- To explore the significance of this relationship in understanding the causes of ED in MSA.
Main Methods:
- Retrospective review of 71 male patients diagnosed with probable MSA.
- Analysis of urogenital symptoms (including ED and lower urinary tract symptoms) and OH.
- Review of laboratory investigations: anal sphincter EMG and autonomic function tests (AFTs).
Main Results:
- Urogenital symptoms were highly prevalent at presentation (96% urinary, 100% ED).
- ED onset preceded bladder symptoms in 58% and OH symptoms in 91% of patients.
- Bladder symptoms preceded OH symptoms in 76% of patients; abnormal EMG/AFTs correlated with symptoms.
Conclusions:
- Urogenital symptoms are common early features in probable MSA, often preceding OH.
- The early onset of ED suggests it may not be solely caused by hypotension in MSA.
- The findings support further investigation into other mechanisms, possibly dopaminergic, for ED in MSA.