Urodynamic study for distinguishing multiple system atrophy from Parkinson disease

ObjectiveTo evaluate the differences in urodynamic findings between multiple system atrophy (MSA) and Parkinson disease (PD) and to identify the differential diagnostic ability of urodynamic study.MethodsWe reviewed patients with MSA or PD who underwent urodynamic studies between January 2011 and August 2018. Patients with probable MSA and PD determined by movement disorder specialists at our center were included. Patients with alleged MSA or PD from outside hospitals, atypical or secondary parkinsonism, and any history of pelvic operation or radiation therapy were excluded.ResultsA total of 219 patients, 107 with MSA (male:female 50:57) and 112 with PD (male:female 57:55), were included. Patients with MSA had shorter disease duration and were referred for urologic evaluation earlier (p < 0.001). Detrusor overactivity and associated urine leakage were prominent in PD (p < 0.001). Patients with MSA showed lower maximal flow rate (4.0 ± 5.8 vs 9.1 ± 8.3 mL/s, p < 0.001) and larger postvoid residual (290.8 ± 196.7 vs 134.0 ± 188.1 mL, p < 0.001) with decreased compliance (44.9% vs 10.7%, p < 0.001) and impaired contractility (24.9 ± 33.8 vs 65.7 ± 51.1, p < 0.001). Postvoid residual from a pressure-flow study had the highest sensitivity and specificity (74.8% and 75.9%), followed by detrusor pressure at maximal uroflow (72.6% and 70.5%), bladder contractility index, and postvoid residual from uroflowmetry (71.0% and 70.5%, respectively).ConclusionsPatients with MSA showed lower maximal flow rate, larger postvoid residual with decreased compliance, and impaired contractility, whereas patients with PD had higher incidence of detrusor overactivity and associated leakage. For differential diagnosis, postvoid residual from a pressure-flow study provided the best sensitivity and specificity.Classification of evidenceThis study provides Class III evidence that urodynamic measures can distinguish patients with MSA from those with PD.

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Bladder outlet obstruction index and maximal flow rate during urodynamic study as powerful predictors for the detection of urodynamic obstruction in women

Neurourology and Urodynamics ◽

10.1002/nau.20375 ◽

2007 ◽

Vol 26 (2) ◽

pp. 247-253 ◽

Cited By ~ 17

Author(s):

Giovanni Luca Gravina ◽

Alessia Mariagrazia Costa ◽

Piero Ronchi ◽

Giuseppe Paradiso Galatioto ◽

Luana Gualà ◽

...

Keyword(s):

Flow Rate ◽

Bladder Outlet Obstruction ◽

Outlet Obstruction ◽

Urodynamic Study ◽

Maximal Flow

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Treatment Strategy According to Findings on Pressure-Flow Study for Women with Decreased Urinary Flow Rate

Advances in Urology ◽

10.1155/2009/782985 ◽

2009 ◽

Vol 2009 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Yoshinori Tanaka ◽

Naoya Masumori ◽

Taiji Tsukamoto ◽

Seiji Furuya ◽

Ryoji Furuya ◽

...

Keyword(s):

Flow Rate ◽

Urinary Flow Rate ◽

Urinary Flow ◽

Pressure Flow ◽

Female Patients ◽

Detrusor Contractility ◽

Urethral Dilatation ◽

Pressure Flow Study ◽

Distigmine Bromide ◽

Flow Study

Purpose. In women who reported a weak urinary stream, the efficacy of treatment chosen according to the urodynamic findings on pressure-flow study was prospectively evaluated.Materials and Methods. Twelve female patients with maximum flow rates of 10 mL/sec or lower were analyzed in the present study. At baseline, all underwent pressure-flow study to determine the degree of bladder outlet obstruction (BOO) and status of detrusor contractility on Schäfer's diagram. Distigmine bromide, 10 mg/d, was given to the patients with detrusor underactivity (DUA) defined as weak/very weak contractility, whereas urethral dilatation was performed using a metal sound for those with BOO (linear passive urethral resistance relation 2–6). Treatment efficacy was evaluated using the International Prostate Symptom Score (IPSS), uroflowmetry, and measurement of postvoid residual urine volume. Some patients underwent pressure-flow study after treatment.Results. Urethral dilatation was performed for six patients with BOO, while distigmine bromide was given to the remaining six showing DUA without BOO. IPSS, QOL index, and the urinary flow rate were significantly improved in both groups after treatment. All four of the patients with BOO and one of the three with DUA but no BOO who underwent pressure-flow study after treatment showed decreased degrees of BOO and increased detrusor contractility, respectively.Conclusions. Both BOO and DUA cause a decreased urinary flow rate in women. In the short-term, urethral dilatation and distigmine bromide are efficacious for female patients with BOO and those with DUA, respectively.

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Fahr Syndrome Unknown Complication: Overactive Bladder

Case Reports in Urology ◽

10.1155/2014/939268 ◽

2014 ◽

Vol 2014 ◽

pp. 1-2

Author(s):

Devrim Tuglu ◽

Ercan Yuvanç ◽

Fatih Bal ◽

Yakup Türkel ◽

Ersel Dağ ◽

...

Keyword(s):

Detrusor Overactivity ◽

Neurogenic Detrusor Overactivity ◽

Urgency Incontinence ◽

Centrum Semiovale ◽

Voiding Diary ◽

Pressure Flow Study ◽

History Of ◽

One Year ◽

Flow Study ◽

Fahr Syndrome

A 38-year-old male patient was admitted to our outpatient department because of frequency and urgency incontinence. During evaluation it was detected that the patient was suffering from frequency which was progressive for one year, feeling of incontinence, and urgency incontinence. There was no urologic pathology detected in patient’s medical and family history. Neurologic consultation was requested due to his history of boredom, reluctance to do business, balance disorders, and recession for about 3 years. Brain computerized tomography (CT) scan revealed that amorphous calcifications were detected in the bilaterally centrum semiovale, basal ganglia, capsula interna, thalami, mesencephalon, pons and bulbus, and the bilateral cerebellar hemispheres. We have detected spontaneous neurogenic detrusor overactivity without sphincter dyssynergia after evaluating the voiding diary, cystometry, and pressure flow study. We consider the detrusor overactivity which occurred one year after the start of the neurological symptoms as the suprapontine inhibition and damage in the axonal pathways in the Fahr syndrome.

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The effect of a 6 Fr catheter in women: Are they obstructive?

Canadian Urological Association Journal ◽

10.5489/cuaj.1320 ◽

2013 ◽

Vol 7 (5-6) ◽

pp. 185 ◽

Cited By ~ 2

Author(s):

Patrick Richard ◽

Nydia Icaza Ordonez ◽

Le Mai Tu

Keyword(s):

Clinical Symptoms ◽

Outlet Obstruction ◽

Urodynamic Study ◽

Double Lumen ◽

Exclusion Criteria ◽

Non Invasive ◽

Transurethral Catheter ◽

Pressure Flow Study ◽

The Mean ◽

Flow Study

Objectives: Our objective was to evaluate the effect of a 6 Fr transurethral catheter on the uroflowmetry and to assess whether it potentially contributes to the bladder outlet obstruction (BOO) in women.Methods: We reviewed the charts of 1367 women who underwent an urodynamic study. We included patients with a non-invasive free-flow study (NIFFS) and pressure flow study (PFS) performed through a 6 Fr double lumen transurethral catheter.Results: In total, 120 women met the inclusion/exclusion criteria. Mean maximal flow rate (Qmax) was significantly higher (p < 0.001) in the NIFFS (27.2±11.1 mL/s) than in the PFS (19.3±10.6 mL/s). The mean difference between both Qmax was 7.9±12.0 mL/s. Of these women, 92.3% (24/26) with a Qmax <12 mL/s during PFS were found to have a Qmax ≥12 mL/s during the NIFFS. Ten of the 72 women with an available Pdet.Qmax were deemed to have a BOO according to the PFS and all of them had a Qmax >12 mL/s during the NIFFS. Of the 10 patients, only 2 reported obstructive symptoms.Conclusion: The presence of 6 Fr transurethral catheters alters the PFS and results in a significant reduction of the Qmax in patients who voided more than 250 mL. We believe that NIFFS should be performed in all patients before any urethral manipulation to lower a possible overdiagnosis of BOO and findings should always be correlated to clinical symptoms.

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