多系统萎缩的泌尿生殖系功能障碍5例报道

目的认识多系统萎缩患者的泌尿生殖系功能障碍特点及影像尿动力学检查的意义。方法报告5例多系统萎缩病例。结果多系统萎缩在泌尿生殖功能障碍上表现为排尿困难、夜间尿频、尿急阳痿等。特征性尿动力学检查结果是残余尿大于100 ml，逼尿肌-尿道外括约肌协同失调，膀胱测压早期出现膀胱颈开放，括约肌肌电图改变有出现自发电位，运动单位电位(MUPs)持续时间超过13 ms，多相波大于60%，影像学检查有不同程度的脑萎缩，脑桥小脑呈“十”字退变。结论本病是一种以神经系统多部位进行性萎缩所致的临床病变，而其中一些萎缩部位在控制泌尿生殖系功能方面起着重要的作用。泌尿生殖系改变与膀胱出口梗阻病变相似，如进行合理的辅助检查，可提高早期多系统萎缩诊断，避免误诊和不必要的外科治疗。

Genitourinary Dysfunction in Multiple System Atrophy: 5 Case Report

ObjectiveTo recognize the features of genitourinary dysfunction in multiple system atrophy (MSA) and the importance of videourodynamics.Methods5 cases of MSA were reviewed.ResultsGenitourinary dysfunction in MSA included voiding problem, nocturnal urinary frequency, urgency, impotence and so on. The characteristic appearance of videourodynamics was that postvoiding volume more than 100 ml, detrusor-external sphincter dyssynergia (DESD) and open bladder neck at the start of bladder filling. The abnormal sphincter electromyography comprised of abnormal spontaneous activity, motor unit potentials (MUPs) more than 13 ms, polyphasic potentials more than 60%. MRI showed brain atrophy and the "hot cross bun" signal in the pontocerebellar degeneration.ConclusionMSA is a disorder characterized by progressive neuronal atrophy at certain sites of the central nervous system that control the urogenital function. MSA-related urological symptoms are analogous with symptoms of bladder outlet obstruction. It is necessary to take some reasonable investigations for avoiding misdiagnosis and unnecessary surgery.