Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Nov;71(5):600–606. doi: 10.1136/jnnp.71.5.600

Videourodynamic and sphincter motor unit potential analyses in Parkinson's disease and multiple system atrophy

R Sakakibara 1, T Hattori 1, T Uchiyama 1, T Yamanishi 1
PMCID: PMC1737611  PMID: 11606669

Abstract

OBJECTIVES—Urinary dysfunction is a prominent autonomic feature in Parkinson's disease (PD) and multiple system atrophy (MSA), which is not only troublesome but also a cause of morbidity in these disorders. Recent advances in investigative uroneurology offer a better insight into the underlying pathophysiology and appropriate management for urinary dysfunction.
METHODS—twenty one patients with PD (15 men, six women, mean age 64 (49-76), mean disease duration 4 years (1-8 years), median Hoehn and Yahr grade 3 (1-4), all taking 300 mg/day of levodopa (100-500 mg)) and 15 with MSA (eight men, seven women, mean age 59 (48-72), mean disease duration 3 years (0.5-6 years)) were recruited. Videourodynamic and sphincter motor unit potential analyses in the patients with PD and MSA were carried out, looking for distinguishing hallmarks that might be useful in the differential diagnosis of these two diseases.
RESULTS—Urinary symptoms were found in 72% of patients with PD and in 100% with MSA. Filling phase abnormalities in the videourodynamic study included detrusor hyperreflexia in 81% of patients with PD and 56% with MSA, and uninhibited external sphincter relaxation in 33% of patients with PD and 33% of those with MSA. However, open bladder neck at the start of filling was not seen in patients with PD but was present in 53% of those with MSA, suggestive of internal sphincter denervation. Sphincter motor unit potential analysis showed neurogenic motor unit potentials in 5% of patients with PD and in 93% of those with MSA, suggestive of external sphincter denervation. On voiding, detrusor-external sphincter dyssynergia was not seen in patients with PD but was present in 47% of those with MSA. Pressure-flow analysis showed that the Abrams-Griffiths number, a grading of urethral obstruction (outflow obstruction >40), in PD (40 in women and 43 in men) was larger than that in MSA (12 in women and 28 in men). Weak detrusor in PD (66% of women and 40% of men) was less common than that in MSA (71% of women and 63% of men). Postmicturition residuals >100 ml were absent in patients with PD but were present in 47% of patients with MSA.
CONCLUSION—Patients with PD had less severe urinary dysfunction with little evidence of internal or external sphincter denervation, by contrast with the common findings in MSA. The findings of postmicturition residuals >100 ml, detrusor-external sphincter dyssynergia, open bladder neck at the start of bladder filling, and neurogenic sphincter motor unit potentials are highly suggestive of MSA.



Full Text

The Full Text of this article is available as a PDF (227.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abrams P. Objective evaluation of bladder outlet obstruction. Br J Urol. 1995 Jul;76 (Suppl 1):11–15. [PubMed] [Google Scholar]
  2. Andersen J. T. Disturbances of bladder and urethral function in Parkinson's disease. Int Urol Nephrol. 1985;17(1):35–41. doi: 10.1007/BF02089401. [DOI] [PubMed] [Google Scholar]
  3. Aranda B., Cramer P. Effects of apomorphine and L-dopa on the parkinsonian bladder. Neurourol Urodyn. 1993;12(3):203–209. doi: 10.1002/nau.1930120302. [DOI] [PubMed] [Google Scholar]
  4. Athwal B. S., Berkley K. J., Hussain I., Brennan A., Craggs M., Sakakibara R., Frackowiak R. S., Fowler C. J. Brain responses to changes in bladder volume and urge to void in healthy men. Brain. 2001 Feb;124(Pt 2):369–377. doi: 10.1093/brain/124.2.369. [DOI] [PubMed] [Google Scholar]
  5. Bannister R., Crowe R., Eames R., Burnstock G. Adrenergic innervation in autonomic failure. Neurology. 1981 Dec;31(12):1501–1506. doi: 10.1212/wnl.31.12.1501. [DOI] [PubMed] [Google Scholar]
  6. Barbalias G. A., Blaivas J. G. Neurologic implications of the pathologically open bladder neck. J Urol. 1983 Apr;129(4):780–782. doi: 10.1016/s0022-5347(17)52361-7. [DOI] [PubMed] [Google Scholar]
  7. Beck R. O., Betts C. D., Fowler C. J. Genitourinary dysfunction in multiple system atrophy: clinical features and treatment in 62 cases. J Urol. 1994 May;151(5):1336–1341. doi: 10.1016/s0022-5347(17)35246-1. [DOI] [PubMed] [Google Scholar]
  8. Blaivas J. G., Sinha H. P., Zayed A. A., Labib K. B. Detrusor-external sphincter dyssynergia: a detailed electromyographic study. J Urol. 1981 Apr;125(4):545–548. doi: 10.1016/s0022-5347(17)55100-9. [DOI] [PubMed] [Google Scholar]
  9. Bonnet A. M., Pichon J., Vidailhet M., Gouider-Khouja N., Robain G., Perrigot M., Agid Y. Urinary disturbances in striatonigral degeneration and Parkinson's disease: clinical and urodynamic aspects. Mov Disord. 1997 Jul;12(4):509–513. doi: 10.1002/mds.870120406. [DOI] [PubMed] [Google Scholar]
  10. Fitzmaurice H., Fowler C. J., Rickards D., Kirby R. S., Quinn N. P., Marsden C. D., Milroy E. J., Turner-Warwick R. T. Micturition disturbance in Parkinson's disease. Br J Urol. 1985 Dec;57(6):652–656. doi: 10.1111/j.1464-410x.1985.tb07025.x. [DOI] [PubMed] [Google Scholar]
  11. Fujita T., Doi M., Ogata T., Kanazawa I., Mizusawa H. Cerebral cortical pathology of sporadic olivopontocerebellar atrophy. J Neurol Sci. 1993 May;116(1):41–46. doi: 10.1016/0022-510x(93)90087-f. [DOI] [PubMed] [Google Scholar]
  12. Galloway N. T. Urethral sphincter abnormalities in Parkinsonism. Br J Urol. 1983 Dec;55(6):691–693. doi: 10.1111/j.1464-410x.1983.tb03406.x. [DOI] [PubMed] [Google Scholar]
  13. Griffiths D. Basics of pressure-flow studies. World J Urol. 1995;13(1):30–33. doi: 10.1007/BF00182663. [DOI] [PubMed] [Google Scholar]
  14. Griffiths D., Höfner K., van Mastrigt R., Rollema H. J., Spångberg A., Gleason D. Standardization of terminology of lower urinary tract function: pressure-flow studies of voiding, urethral resistance, and urethral obstruction. International Continence Society Subcommittee on Standardization of Terminology of Pressure-Flow Studies. Neurourol Urodyn. 1997;16(1):1–18. doi: 10.1002/(sici)1520-6777(1997)16:1<1::aid-nau1>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  15. Hattori T., Yasuda K., Kita K., Hirayama K. Voiding dysfunction in Parkinson's disease. Jpn J Psychiatry Neurol. 1992 Mar;46(1):181–186. doi: 10.1111/j.1440-1819.1992.tb00832.x. [DOI] [PubMed] [Google Scholar]
  16. Kirby R., Fowler C., Gosling J., Bannister R. Urethro-vesical dysfunction in progressive autonomic failure with multiple system atrophy. J Neurol Neurosurg Psychiatry. 1986 May;49(5):554–562. doi: 10.1136/jnnp.49.5.554. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Mannen T., Iwata M., Toyokura Y., Nagashima K. The Onuf's nucleus and the external anal sphincter muscles in amyotrophic lateral sclerosis and Shy-Drager syndrome. Acta Neuropathol. 1982;58(4):255–260. doi: 10.1007/BF00688606. [DOI] [PubMed] [Google Scholar]
  18. McGuire E. J., Brady S. Detrusor-sphincter dyssynergia. J Urol. 1979 Jun;121(6):774–777. doi: 10.1016/s0022-5347(17)56987-6. [DOI] [PubMed] [Google Scholar]
  19. McGuire E. J. Reflex urethral instability. Br J Urol. 1978 May;50(3):200–204. doi: 10.1111/j.1464-410x.1978.tb02802.x. [DOI] [PubMed] [Google Scholar]
  20. Morgan C., Nadelhaft I., de Groat W. C. Location of bladder preganglionic neurons within the sacral parasympathetic nucleus of the cat. Neurosci Lett. 1979 Oct;14(2-3):189–194. doi: 10.1016/0304-3940(79)96146-9. [DOI] [PubMed] [Google Scholar]
  21. Nordling J., Meyhoff H. H., Olesen K. P. Cysto-urethrographic appearance of the bladder and posterior urethra in neuromuscular disorders of the lower urinary tract. Scand J Urol Nephrol. 1982;16(2):115–124. doi: 10.3109/00365598209179739. [DOI] [PubMed] [Google Scholar]
  22. Palace J., Chandiramani V. A., Fowler C. J. Value of sphincter electromyography in the diagnosis of multiple system atrophy. Muscle Nerve. 1997 Nov;20(11):1396–1403. doi: 10.1002/(sici)1097-4598(199711)20:11<1396::aid-mus7>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  23. Pramstaller P. P., Wenning G. K., Smith S. J., Beck R. O., Quinn N. P., Fowler C. J. Nerve conduction studies, skeletal muscle EMG, and sphincter EMG in multiple system atrophy. J Neurol Neurosurg Psychiatry. 1995 May;58(5):618–621. doi: 10.1136/jnnp.58.5.618. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Rodi Z., Denislic M., Vodusek D. B. External anal sphincter electromyography in the differential diagnosis of parkinsonism. J Neurol Neurosurg Psychiatry. 1996 Apr;60(4):460–461. doi: 10.1136/jnnp.60.4.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Sakakibara R., Fowler C. J., Hattori T., Hussain I. F., Swinn M. J., Uchiyama T., Yamanishi T. Pressure-flow study as an evaluating method of neurogenic urethral relaxation failure. J Auton Nerv Syst. 2000 Apr 12;80(1-2):85–88. doi: 10.1016/s0165-1838(99)00078-8. [DOI] [PubMed] [Google Scholar]
  26. Sakakibara R., Hattori T., Tojo M., Yamanishi T., Yasuda K., Hirayama K. Micturitional disturbance in multiple system atrophy. Jpn J Psychiatry Neurol. 1993 Sep;47(3):591–598. doi: 10.1111/j.1440-1819.1993.tb01804.x. [DOI] [PubMed] [Google Scholar]
  27. Sakakibara R., Hattori T., Uchiyama T., Kita K., Asahina M., Suzuki A., Yamanishi T. Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation? J Neurol Neurosurg Psychiatry. 2000 Jan;68(1):65–69. doi: 10.1136/jnnp.68.1.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Sakuta M., Nakanishi T., Toyokura Y. Anal muscle electromyograms differ in amyotrophic lateral sclerosis and Shy-Drager syndrome. Neurology. 1978 Dec;28(12):1289–1293. doi: 10.1212/wnl.28.12.1289. [DOI] [PubMed] [Google Scholar]
  29. Sand P. K., Bowen L. W., Ostergard D. R. Uninhibited urethral relaxation: an unusual cause of incontinence. Obstet Gynecol. 1986 Nov;68(5):645–648. [PubMed] [Google Scholar]
  30. Schurch B., Yasuda K., Rossier A. B. Detrusor bladder neck dyssynergia revisited. J Urol. 1994 Dec;152(6 Pt 1):2066–2070. doi: 10.1016/s0022-5347(17)32310-8. [DOI] [PubMed] [Google Scholar]
  31. Schäfer W. Principles and clinical application of advanced urodynamic analysis of voiding function. Urol Clin North Am. 1990 Aug;17(3):553–566. [PubMed] [Google Scholar]
  32. Stocchi F., Carbone A., Inghilleri M., Monge A., Ruggieri S., Berardelli A., Manfredi M. Urodynamic and neurophysiological evaluation in Parkinson's disease and multiple system atrophy. J Neurol Neurosurg Psychiatry. 1997 May;62(5):507–511. doi: 10.1136/jnnp.62.5.507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Wagg A. S., Lieu P. K., Ding Y. Y., Malone-Lee J. G. A urodynamic analysis of age associated changes in urethral function in women with lower urinary tract symptoms. J Urol. 1996 Dec;156(6):1984–1988. [PubMed] [Google Scholar]
  34. Wenning G. K., Ben-Shlomo Y., Hughes A., Daniel S. E., Lees A., Quinn N. P. What clinical features are most useful to distinguish definite multiple system atrophy from Parkinson's disease? J Neurol Neurosurg Psychiatry. 2000 Apr;68(4):434–440. doi: 10.1136/jnnp.68.4.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Wenning G. K., Scherfler C., Granata R., Bösch S., Verny M., Chaudhuri K. R., Jellinger K., Poewe W., Litvan I. Time course of symptomatic orthostatic hypotension and urinary incontinence in patients with postmortem confirmed parkinsonian syndromes: a clinicopathological study. J Neurol Neurosurg Psychiatry. 1999 Nov;67(5):620–623. doi: 10.1136/jnnp.67.5.620. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Yamanishi T., Yasuda K., Sakakibara R., Hattori T., Tojo M. The effectiveness of terazosin, an alpha1-blocker, on bladder neck obstruction as assessed by urodynamic hydraulic energy. BJU Int. 2000 Feb;85(3):249–253. doi: 10.1046/j.1464-410x.2000.00418.x. [DOI] [PubMed] [Google Scholar]
  37. Yoshimura N., Mizuta E., Yoshida O., Kuno S. Therapeutic effects of dopamine D1/D2 receptor agonists on detrusor hyperreflexia in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned parkinsonian cynomolgus monkeys. J Pharmacol Exp Ther. 1998 Jul;286(1):228–233. [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES