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Micturitional disturbance in multiple system atrophy

R Sakakibara1, T Hattori, M Tojo

  • 1Department of Neurology, Chiba University School of Medicine, Japan.

The Japanese Journal of Psychiatry and Neurology
|September 1, 1993
PubMed
Summary

Micturitional disturbances are prevalent in multiple system atrophy (MSA), with Shy-Drager syndrome (SDS) showing earlier and more severe symptoms. Lesions in pelvic and pudendal nerves contribute to these urinary issues, progressing with the disease.

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Area of Science:

  • Neurology
  • Urology

Background:

  • Multiple System Atrophy (MSA) is a neurodegenerative disorder.
  • Micturitional dysfunction is a common but understudied symptom in MSA.
  • Different subtypes of MSA include striatonigral degeneration (SND), olivopontocerebellar atrophy (OPCA), and Shy-Drager syndrome (SDS).

Purpose of the Study:

  • To investigate the characteristics and underlying mechanisms of micturitional disturbances in patients with MSA.
  • To compare the prevalence and severity of urinary symptoms across different MSA subtypes.
  • To identify the neurological sites responsible for micturitional dysfunction in MSA.

Main Methods:

  • Detailed micturitional histories were collected from 86 patients with MSA (14 SND, 42 OPCA, 30 SDS).
  • Urodynamic studies were performed to assess bladder function.

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  • Lesion sites affecting pelvic and pudendal nerves were investigated.

    • Main Results:

    • Over 90% of MSA patients experienced micturitional symptoms.
    • SND and OPCA predominantly showed irritative symptoms, while SDS presented with both irritative and obstructive symptoms.
    • Micturitional issues appeared earlier and were more severe in SDS compared to SND and OPCA.
    • Urinary dysfunction worsened with disease progression.
    • Both supra- and infranuclear lesions of pelvic and pudendal nerves were implicated, with infranuclear lesions being more prominent in SDS.

    Conclusions:

    • Micturitional disturbances are a significant and common feature of MSA, varying in presentation and severity across subtypes.
    • Shy-Drager syndrome is associated with earlier onset and more severe urinary symptoms due to prominent infranuclear nerve lesions.
    • The progression of MSA involves changes in lesion sites, potentially shifting from supranuclear to infranuclear involvement of the pelvic nerves, impacting bladder control.