HOW TO RECOGNIZE PATIENTS WITH PARKINSONISM WHO SHOULD NOT HAVE UROLOGICAL SURGERY

Objective To examine whether there are urogenital criteria that the ur ologist could apply to a patient with idiopathic Parkinson's disease ( IPD) and bladder symptoms, and so avoid operating on patients with mul tiple system atrophy (MSA). Patients and methods The clinical features of 52 patients with probable MSA and 41 patients with TPD were studie d retrospectively with particular attention to the nature of lower uri nary tract symptoms and erectile dysfunction in relation to the onset of parkinsonism. Anal sphincter electromyography (EMG) was recorded in all the patients with MSA and in 12 of the patients with IPD. Results Of the patients with MSA, 60% had urinary symptoms preceding or prese nting with IPD but in 94% of the patients with IPD the neurological di agnosis preceded the onset of urogenital symptoms. Most of the patient s with MSA (73%) had troublesome urinary incontinence whereas the majo rity of those with IPD (85%) had urgency and frequency but were not in continent; 66% of the patients with MSA and 16% of patients with TPD h ad a significant post-void residual volume. Of the men with MSA, 93% h ad erectile dysfunction and in 48% of them this complaint preceded the diagnosis of MSA. All 11 men with MSA who had a TURF were incontinent post-operatively. Conclusion The urogenital criteria which favour a d iagnosis of MSA are: (i) urinary symptoms preceding or presenting with parkinsonism; (ii) urinary incontinence and IPD; (iii) a significant post-void residual urine volume; (iv) erectile failure preceding or pr esenting with parkinsonism; and (v) worsening bladder control after ur ological surgery, Patients with parkinsonism and these features should be offered medical management rather than urological surgery.