Urodynamic study for distinguishing multiple system atrophy from Parkinson’s disease
Jung Hyun Shin (1), Ji-Yeon Han (2), Myung-Soo Choo (1)
1Asan Medical Center, Seoul, South Korea, (2) Pusan National University Yangsan Hospital, Yangsan, South Korea
To evaluate the differences in urodynamic findings between multiple system atrophy (MSA) and Parkinson’s disease (PD), and identify the differential diagnostic ability of urodynamic study.
We reviewed MSA or PD patients who underwent urodynamic studies between January 2011 and August 2018. Probable MSA and PD patients determined by movement disorder specialists of our center were included. Patients with alleged MSA or PD from outside hospitals, atypical or secondary Parkinsonism, any history of pelvic operation or radiation therapy were excluded.
A total of 219 patients; 107 MSA (M:F=50:57) and 112 PD (M:F=57:55) were included. MSA patients had shorter disease duration and were referred for urological evaluation earlier (p < 0.001). Detrusor overactivity and associated urine leakage was prominent in PD (p < 0.001). MSA patients showed lower maximal flow rate (4.0±5.8 ml/s vs. 9.1±8.3 ml/s, p < 0.001), larger post-void residual (290.8±196.7 ml vs. 134.0±188.1 ml, p < 0.001) with decreased compliance (44.9% vs. 10.7%, p < 0.001), and impaired contractility (24.9±33.8 vs. 65.7±51.1, p < 0.001). Post-void residual from pressure-flow study had the highest sensitivity and specificity (74.8% and 75.9%), followed by detrusor pressure at maximal uroflow (72.6% and 70.5%), bladder contractility index and post-void residual from uroflowmetry (71.0% and 70.5%, respectively).
MSA patients showed lower maximal flow rate, larger post-void residual with decreased compliance and impaired contractility, whereas PD patients had higher incidence of detrusor overactivity and associated leakage. For differential diagnosis, post-void residual from pressure-flow study provided the best sensitivity and specificity.