title: Impaired detrusor contractility is the pathognomonic urodynamic finding of multiple system atrophy compared to idiopathic Parkinson's disease.
abstract: BACKGROUND
  To investigate differences in urodynamic parameters between two groups: Parkinson's disease (PD) and multiple system atrophy (MSA) patients.
  
  
  METHODS
  A retrospective study was performed in patients with PD and MSA who presented to three referral centers between 2005 and 2012. Patients referred to the urology department for lower urinary tract symptoms underwent urodynamic studies. Patients with other rare or ambiguous subtypes of PPS, urinary tract infection, urinary stones, or other neurogenic conditions were excluded from the analysis.
  
  
  RESULTS
  A total of 581 consecutive patients (359 men and 222 women) were analyzed. The mean patient age was 69.2 (SD, 9.3) years. Among these patients, 390 (64.3%) had PD, and 191 (31.5%) had MSA. Patients with MSA showed a statistically significantly decreased maximal flow rate and increased post-void residual urine volume compared with patients with PD (P range, <0.001-0.005). In addition, voiding failure occurred more frequently in patients with MSA than in those with PD (odds ratio [OR] = 1.9; 95% confidence interval [CI], 1.26-2.73). Patients with MSA showed a higher prevalence of low-compliance (P = 0.001), decreased bladder contractility (P < 0.001), and an increased rate of voiding failure (P = 0.001). In patients with MSA, decreased detrusor contractility was more prominent in the cerebellar ataxia predominant subtype (MSA-C; P = 0.038). Multivariate analysis showed that the MSA subtype was the only independent risk factor for impaired detrusor contractility (men, OR = 2.692; P = 0.006; women, OR = 2.965; P = 0.007).
  
  
  CONCLUSIONS
  Impaired detrusor contractility was the pathognomonic urodynamic finding that distinguished MSA from PD.
authors.affiliation: Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea. Electronic address: flytoyou@gmail.com.
authors.forename: Myong
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea. Electronic address: genejh@hanmail.net.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Jung
authors.affiliation: Department of Urology, SMG-SNU Boramae Medical Center, Donggak-gu, Boramae-ro 5 Gil, 20, Seoul 156-707, Republic of Korea. Electronic address: insitu80@naver.com.
authors.forename: Juhyun
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Urology, SMG-SNU Boramae Medical Center, Donggak-gu, Boramae-ro 5 Gil, 20, Seoul 156-707, Republic of Korea. Electronic address: volley@snu.ac.kr.
authors.forename: Hwancheol
authors.initials: H
authors.lastname: Son
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam-si, Bundang-gu, Gumi-ro 173 Gil, 82, Kyunggi Province 463-707, Republic of Korea. Electronic address: urojsj@empal.com.
authors.forename: Seong Jin
authors.initials: SJ
authors.lastname: Jeong
authors.affiliation: Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea. Electronic address: sjo@snu.ac.kr.
authors.forename: Seung-June
authors.initials: SJ
authors.lastname: Oh
authors.affiliation: Department of Urology, SMG-SNU Boramae Medical Center, Donggak-gu, Boramae-ro 5 Gil, 20, Seoul 156-707, Republic of Korea. Electronic address: kmoretry@daum.net.
authors.forename: Sung Yong
authors.initials: SY
authors.lastname: Cho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications*; D010300:Parkinson Disease / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012727:Sex Characteristics; D053201:Urinary Bladder, Overactive / Q000209:etiology*; D014563:Urodynamics / Q000502:physiology*
keywords: Lower urinary tract symptoms; Multiple system atrophy; Parkinson disease; Parkinson plus syndrome; Urodynamics