Objective: To evaluate differences in urodynamic findings between multiple system atrophy (MSA) and Parkinson’s disease (PD) and identify the utility of urodynamic parameters for the differential diagnosis.

Background: Urinary dysfunction is one of the differential diagnostic clues to differentiate MSA from PD. Severe symptomatic autonomic failure including urinary incontinence a prognostic indicator of survival in MSA. Urodynamic study is a gold standard tool for evaluating voiding dysfunction in patients with neurologic deficits. However, little is known about the urodynamic feature of MSA except for large post-void residual volume.

Method: We retrospectively reviewed patients with probable MSA or PD who underwent urodynamic studies from January 2011 to August 2018. Patients with possible MSA or PD, secondary Parkinsonism, any history of pelvic operation and radiation therapy were excluded. Primary aim was to compare the parameters of urodynamic studies between MSA and PD. Secondary aim was to compare the sensitivity and specificity of the major urodynamic parameters for the differential diagnosis between MSA and PD.

Results: A total 107 MSA patients and 112 PD patients were included. In uroflowmetry, MSA patients showed lower maximal flow rate (4.0±5.8 ml/s vs. 9.1±8.3 ml/s, p<0.001) and larger post-void residual (290.8±196.7 ml vs. 134.0±188.1 ml, p<0.001) compared with PD patients. In pressure flow study, MSA patients showed lower maximal flow rate (3.5 ± 5.0 ml/s vs. 8.2 ± 7.4 ml/s, p<0.001) and larger post-void residual (361.5 ± 169.6 ml vs. 146.1 ± 178.0 ml, p<0.001), decreased compliance (44.9% vs. 10.7%, p<0.001),  impaired contractility (24.9±33.8 vs. 65.7±51.1, p<0.001) and lower PdetQmax (7.4 ± 14.7 vs 24.9 ± 27.7, p<0.001) compared with PD patients. Detrusor overactivity and associated leakage was more prominent in PD compared with MSA (36% vs. 88%, p<0.001). Post-void residual from pressure-flow study was the only parameter with AUC value > 0.8 among the seven parameters, followed by PdetQmax.

Conclusion: MSA patients showed lower maximal flow rate, larger post-void residual with decreased compliance and impaired contractility, whereas PD patients had higher incidence of detrusor overactivity and associated leakage. For differential diagnosis, post-void residual from pressure-flow study provided the best sensitivity and specificity.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/urodynamic-study-to-distinguish-multiple-system-atrophy-from-parkinsons-disease/