Document Detail

Erectile and urinary dysfunction may be the presenting features in patients with multiple system atrophy: a retrospective study.
MedLine Citation:
PMID:  12934060     Owner:  NLM     Status:  MEDLINE    
Multiple system atrophy (MSA) is a progressive neurodegenerative disease characterized by parkinsonism and cerebellar, autonomic, urinary, and/or pyramidal dysfunction. Urinary and erectile dysfunction (ED) symptoms are prominent early features in men with MSA. Autonomic failure, considered until recently to be the cause of ED in these men, is commonly expressed through symptoms of orthostatic hypotension (OH). The aim of this retrospective study is to examine the chronological relationship between the development of urogenital symptoms and those of OH in patients diagnosed with MSA and discuss its significance in the aetiology of ED in these patients. A total of 71 male patients, referred to a Uro-Neurology department with a diagnosis of 'probable MSA', were reviewed in terms of 'autonomic' symptoms only--OH and lower urinary tract symptoms, accompanied by ED--present at the time of their referral. Laboratory investigations including anal sphincter EMG and/or autonomic function tests (AFTs) were performed in 75 and 90% of the patients, respectively. At presentation, urinary complaints were recorded in 96% of patients and ED in all patients that this was inquired about. The onset of ED had preceded the onset of bladder symptoms in 58% and the onset of OH symptoms in 91% of these men. Bladder symptoms also preceded symptoms of OH in 76% of patients. Sphincter EMG was abnormal in 91% and AFTs in 77% of the patients tested. Almost all patients with abnormal EMG had troublesome urinary symptoms. AFTs showed similar sensitivity relating to symptoms. At presentation, urogenital symptoms are common in patients with probable MSA and are often not accompanied by symptoms of OH. The earlier occurrence of ED in men with MSA suggests a lack of a causal relationship to hypotension. The notion that MSA possibly affects the dopaminergic mechanism of erectile function is discussed.
K Kirchhof; A N Apostolidis; C J Mathias; C J Fowler
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of impotence research     Volume:  15     ISSN:  0955-9930     ISO Abbreviation:  Int. J. Impot. Res.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-22     Completed Date:  2003-10-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9007383     Medline TA:  Int J Impot Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  293-8     Citation Subset:  IM    
Department of Neurology, Division of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany.
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MeSH Terms
Anal Canal / physiopathology
Autonomic Nervous System / physiopathology
Erectile Dysfunction / etiology*
Middle Aged
Multiple System Atrophy / complications*,  physiopathology
Retrospective Studies
Shy-Drager Syndrome / etiology
Urinary Bladder Diseases / etiology
Urination Disorders / etiology*

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