Neuro-Urology pp 135-151 | Cite as

Multiple System Atrophy

  • Ryuji Sakakibara


Urinary dysfunction is a prominent autonomic feature in patients with MSA, and it is more common (above 90%) and occurs earlier than postural hypotension in this disorder. Since the clinical features of MSA may mimic those of IPD, a distinctive pattern of urinary dysfunction in both disorders is worth looking at. In contrast to IPD, MSA patients have more marked urinary dysfunction, which consists of both urgency incontinence and post-void residuals >100 ml. Videourodynamic and sphincter EMG analyses are important tools for understanding the extent of these dysfunctions and for determining both the diagnosis and management of the disorders. The common finding in both disorders is bladder overactivity, which accounts for urinary urgency and frequency. However, detrusor-sphincter dyssynergia, open bladder neck at the start of bladder filling (internal sphincter denervation), and neurogenic sphincter EMG (external sphincter denervation) are all characteristics of MSA. These features may reflect pathological lesions in the basal ganglia, pontine tegmentum, raphe, intermediolateral cell column, and sacral Onuf’s nuclei. During the course of the disease, the pathophysiological balance shifts from central to peripheral, with bladder emptying disorder predominating. Since MSA is a progressive disorder and impaired detrusor contractility is common, it is important to avoid inappropriate urological surgery in patients with MSA. A conservative approach with medical measures includes anticholinergics for urinary urgency and frequency, desmopressin for nocturnal polyuria, uro-selective alpha-blockers and cholinergic stimulants for voiding difficulty, and CIC for large PVR.


Multiple system atrophy Urinary dysfunction Parkinson’s disease Urgency incontinence Urinary retention Urodynamics Sphincter electromyography Onuf’s nucleus Clean intermittent catheterization 


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologyInternal Medicine, Sakura Medical Center, Toho UniversitySakuraJapan

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