Editing Neurogenic LUT Dysfunction (section)

=== Multiple system atrophy ===

* A progressive neurodegenerative disease of unknown cause; results from glial α-synucleinopathy
* Symptoms encompass parkinsonism and cerebellar, autonomic (including urinary and erectile problems), and pyramidal cortical dysfunction in a multitude of combinations
* The neurologic lesions of MSA consist of cell loss and gliosis in widespread areas and occur to a significantly greater degree than with PD. This more diffuse nature of cell loss probably explains why '''bladder symptoms may occur earlier and be more severe than in PD, and why erectile function may be affected as well'''
* '''The initial urinary symptoms of MSA are urgency, frequency, and urgency incontinence, occurring up to 4 years before the diagnosis is made.'''
** As would be expected from the central nervous system (CNS) areas affected, '''detrusor overactivity is frequently found'''
** Decreased compliance may also occur, reflecting distal spinal involvement of the locations of the cell bodies of autonomic neurons innervating the LUT.
** As the disease progresses, difficulty in initiating and maintaining voiding may occur, probably from pontine and sacral cord lesions, and this usually is associated with a poor prognosis.
** Cystourethrography or video-urodynamic studies may reveal an '''open bladder neck''' (different than PD), and many patients exhibit evidence of '''striated sphincter denervation on motor unit electromyography.'''
* '''Management'''
** The treatment of LUTS caused by MSA is difficult
** Treatment of detrusor overactivity during filling may worsen problems initiating voluntary micturition or worsen impaired contractility during emptying.
** '''Patients usually have smooth and striated sphincter insufficiency predisposing females to sphincteric incontinence and making outlet-reducing procedures (prostatectomy) hazardous in males''' (different than PD)
** Conversely, drug treatment for sphincteric incontinence may further worsen emptying problems.
** In general, the goal in these patients is to facilitate storage, and CIC would often be desirable. Unfortunately, patients with advanced disease often are not candidates for CIC.
** Some patients do respond well to desmopressin administration for predominant nocturia; however, the majority of the patients do not respond well to antimuscarinic or other types of therapy