Urodynamic analysis in multiple system atrophy: characterisation of detrusor-sphincter dyssynergia |
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Authors: | Frédéric Bloch Bertrand Pichon Anne-Marie Bonnet Jacques Pichon Marie Vidailhet Emmanuel Roze Michel Perrigot |
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Institution: | 1. AP-HP, Centre d’Investigation Clinique (CIC), Université Pierre et Marie Curie-Paris 6, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France 2. AP-HP, Médecine Physique et Réadaptation, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France 3. AP-HP, Fédération des Maladies du Système Nerveux, Université Pierre et Marie Curie-Paris 6, CRICM UPMC/INSERM UMRS-975, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
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Abstract: | In multiple system atrophy (MSA), parkinsonism and a cerebellar syndrome are associated with autonomic dysfunction. Both bladder
neck dysfunction and external sphincter denervation have been implicated in detrusor-sphincter dyssynergia. However, urethral
dysfunction may not be adequately reflected by a single global measurement of urethral pressure. Pressure assessment at several
levels of the urethra is needed to unravel the mechanisms of bladder-urethra dysfunction. Here, we evaluated the use of multiple
sensor pressure transducers to assess bladder-sphincter function in 52 patients with MSA in comparison to patients with Parkinson’s
disease (PD) who were matched for age and severity in the “off” condition. Urinary dysfunction appeared significantly earlier
in MSA (<2 years) than in PD (>5 years). Detrusor under-activity with dysuria was observed in 58% of MSA patients within 4 years
and in 76% of patients thereafter. Detrusor-urethral dyssynergia in MSA patients was always better characterized by multiple
sensor pressure transducer measurement of bladder and urethral pressure than by a single global measurement. This new approach
may prove useful for differential diagnosis of parkinsonian syndromes, and especially MSA. |
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