Urodynamic Study Between Parkinson’s Disease And Multiple System Atrophy Patients With Lower Urinary Tract Symptoms

BackgroundParkinson’s disease(PD)and multiple system atrophy(MSA)are common neurodegenerative diseases in middle-aged and elderly patients.Both diseases are typically characterized by motor symptoms.However,more and more studies have shown that the occurrence of autonomic nervous symptoms is related to the prognosis of patients,and the earlier the occurrence of autonomic nervous symptoms,the worse the prognosis.Especially in MSA patients,autonomic nervous symptoms usually precede motor symptoms and are often the first symptoms in the early stages of the disease.Urological symptoms are the most common autonomic nervous symptoms in PD and MSA,and may occur in the early stages of the disease or when the disease is not clearly diagnosed.Therefore,urologists may be the first to receive such patients.However,due to insufficient understanding of the urinary symptoms of PD and MSA or neglect that PD and MSA can produce urinary symptoms at an early stage,the diagnosis of urinary symptoms in such patients as simple urinary symptoms rather than accompanying symptoms of the disease may affect the diagnosis and treatment of the disease.In addition,urinary tract symptoms of PD and MSA seriously affect the quality of life of patients,and the advanced stage of the disease may lead to renal failure and endanger the life of patients.Therefore,it is necessary to study the lower urinary tract symptoms(LUTS)of PD and MSA.Urodynamic examination is a necessary tool for the study of LUTS to assess bladder function and guide patient treatment.The study of urodynamics in patients with PD and MSA with lower urinary tract symptoms may alert clinicians to these diseases and provide evidence for the management of their urinary tract symptoms.Objective1.To compared the urinary tract symptoms of PD and MSA patients with LUTS,and clarify their clinical performance characteristic in both diseases.2.To evaluate the urodynamic characteristics of PD and MSA patients with LUTS,and provide more accurate treatment for such patients.MethodsWe performed a retrospective study in PD and MSA patients admitted to our hospital and undergone urodynamic examinations from January 2016 to June 2019.A total of 178 patients,mean age(59.2±9.7)years old were enrolled,including 64 cases of PD(male/femal:33/31),74 cases of MSA(male/femal:45/29)and 40 cases of normal control group(male/femal:22/18).Inclusion criteria for patients with PD and MSA should also meet the following criteria:2 neurologists diagnosed or suspected diagnosed PD and MSA patients according to diagnostic criteria;urodynamic examination was performed and the data were complete;no use of Parkinson’s medication or discontinuation of medication for at least 4-5 weeks at the time of revisit.Exclusion criteria:diseases with clear neurological damage causing LUTS,such as cerebral infarction,diabetes,spinal disease,mental disease,history of pelvic surgery;patients with incomplete urodynamic measurements,or who have not completed all examinations successfully for other reasons.The control group was the group of patients who underwent urodynamic examination with normal results due to other causes(suspected urinary incontinence,hydronephrosis,uterine fibroids,etc.requiring pelvic surgery,or patients with unexplained frequency of urination and urgent need to determine the presence or absence of bladder hyperactivity)in the same period and similar age.Urodynamic parameters,Maximum flow rate(Qmax),post-void residual volume(PVR),bladder compliance(BC),overactive bladder(OAB),maximum cystometric capacity(MCC),detrusor pressure at maximum flow(PdetQmax)were recorded and analyzed to evaluate bladder function.Results1.The characteristic of low urinary tract of patients Frequent(68.8%)was the most common LUTS in PD patients,as opposed to urinary retention(91.9%)in MSA patients,and the incidence of urgency and urinary retention in MSA patients was significantly higher than that in PD patients(46.9%vs.54.1%,32.8%vs.91.9%,P<0.05).2.Compared with PD and MSA The Qmax,PdetQmax and incident of OAB were higher and the PVR and the poor of BC were lower in PD patients than in MSA patients[free-flo w(FF)-Qmax:(13.5±7.1)ml/s vs.(10.1±5.2)ml/s,U=26.98,P<0.01;pressure-flo w study(PFS)-Qmax:(13.6±5.7)ml/s vs.(10.5±3.3)ml/s,U=34.90,P’<0.01;P FS-PdetQmax:(23.9±11.3)cmH2O vs.(16.3±8.6)cmH2O,U=35.04,P’<0.01;OA B:46.9%vs.27.0%,χ2=5.85,P’<0.018;FF-PVR:(30.4±20.0)ml vs.(161.7±79.8)ml,U=-71.81,P’<0.01;PFS-PVR:(65.9±30.7)ml vs.(212.6±83.0)ml,U=-65.29,P’<0.01;BC:10.9%vs.28.4%,χ2=6.46,P’<0.018].3.Compared with PD and the control group The incidences of OAB and PFS-PVR were higher and the MCC and Pdet Qmax were lower in the PD group than the control group[(OAB:46.9%vs.7.5%,χ2=6.15,P’<0.018);PFS-PVR:(65.9±30.7)ml vs.(22.2±10.4)ml,U=47.25,P’<0.01;MCC(305.1±79.7)ml vs.(389.6±65.2)ml,U=-52.13,P’<0.01);PdetQmax:(23.9±11.3)cmH2O vs.(37.3±10.3)cmH2O,U=-49.88,P’<0.01].4.Compared with MSA and the control group The MSA group had a lower Qmax,PdetQmax and MCC:[FF-Qmax:(10.1±5.2)ml/s vs.(16.3±4.7)ml/s,U=-50.11,P’<0.01;PFS-Qmax:(10.5±3.3)ml/s vs.(13.1±5.0)ml/s,U=-27.54,P’>0.018;PdetQmax:(16.3±8.6)cmH2O vs.(37.3± 10.3)cmH2O,U=-84.92,P’<0.01;MCC:(284.3±71.8)ml vs.(389.6±65.2)ml,U=-39.31,P’<0.01],a higher PVR,less BC and a higher incidence of OAB[FF-PVR:(161.7±79.8)ml vs.(22.0±13.0)ml,U=84.82,P’<0.01;PFS-PV R:(212.6±83.0)ml vs.(22.2±10.4)ml,U=112.54,P’<0.01;BC:28.4%vs.7.5%,χ2=6.81,P’<0.01;OAB:27.0%vs.7.5%,χ2=17.62,P’<0.01].Conclusion1.Urinary frequency was the most common LUTS in PD patients,while urinary retention was the main symptom in MSA patients.2.PD and MSA patients with LUTS both had significant urodynamic changes,and PD patients had more DO,PVR was more common in MSA patients.This show that the treatment of OAB should be attention in PD patient and removing PVR was the focus of treatment in MSA patients.