Video Urodynamic Study in Patients with Parkinson's Disease and Multiple System Atrophy

Background: Most studies have analyzed the urodynamic characteristics of patients with Parkinson's disease (PD) and multiple system atrophy (MSA) using conventional urodynamic studies. Objectives: This study investigated the urodynamic characteristics of both diseases using video urodynamic study (VUDS). Methods: VUDS results from November 2004 to September 2020 were retrospectively analyzed at Seoul National University Hospital. The VUDS findings in patients with PD and those with MSA were compared. Movement disorder specialists diagnosed patients with PD and MSA. Results: A total of 709 patients, comprising 364 PD (260 men, 104 women) and 345 MSA (215 men, 130 women) cases, were identified. Patients with MSA had a significantly younger age at onset, lower maximum flow rate (Qmax), larger postvoid residual volume, higher rate of poor bladder compliance, higher prevalence of urinary incontinence, and lower detrusor pressure at Qmax than those with PD. Among the fluoroscopic findings of VUDS, patients with MSA had a higher rate of incompetent bladder neck (18.8% vs. 4.7%, P < 0.001), bladder trabeculation (33.0% vs. 17.0%, P < 0.001), and vesicoureteral reflux (2.9% vs. 0.5%, P = 0.019) than those with PD. In VUDS performed in patients without urinary incontinence in conventional urodynamic study, an incompetent bladder neck was found in 14.6% of patients with MSA and 3.3% of patients with PD (P < 0.001). Conclusions: Our results demonstrate that VUDS can provide additional information on bladder urethral dysfunction, particularly regarding the risk of upper urinary tract damage and bladder neck status in patients with PD and MSA.