MICTURITIONAL DISTURBANCE IN MULTIPLE SYSTEM ATROPHY

Detailed micturitional histories and urodynamic studies were conducted to investigate the micturitional disturbance in multiple system atrop hy (MSA). Eighty-six patients with MSA comprised of 14 with striatonig ral degeneration (SND), 42 with alivopontocerebellar atrophy (OPCA) an d 30 with Shy-Drager syndrome (SDS). The results were as follows. Mict uritional symptoms were noted in over 90% of patients with each type o f MSA. Dominant symptoms were irritative ones in SND and OPCA, and a c ombination of irritative and obstructive ones in SDS. Micturitional sy mptoms in SDS appeared earlier than those in SND or OPCA. The degree o f micturitional disturbance was severer in SDS than in SND or OPCA. Mi cturitional disturbance tended to become worse as the disease progress ed. The responsible sites of lesions of micturitional disturbance seem ed to be supra- as well as infranuclear lesions of the pelvic and pude ndal nerves in MSA. Infranuclear lesions were more prominent in SDS th an in SND or OPCA. Follow-up studies of some of the patients with SDS and OPCA suggested that the responsible sites of pelvic nerve lesions changed from supra- to infranuclear lesions during the course of disea se.