The Value Urodynamic Study In The Diagnosis And Differential Diagnosis Of Multiple System Atrophy And Parkinson’s Disease

Background and ObjectiveMultiple system atrophy(MSA)is an adult-onset,fatal,and progressive neurodegenerative disease.The main clinical manifestations are autonomic dysfunction,Parkinson’s symptoms,cerebellar ataxia symptoms,and pyramidal tract signs.Parkinson’s disease(PD)is the second most common and sporadic neurodegenerative disease after Alzheimer’s disease.The main clinical manifestations are motor symptoms such as bradykinesia,rigidity,static tremor,and abnormal posture and gait.The clinical manifestations of MSA and PD are similar,but the progression and prognosis of the two diseases are quite different,so it is necessary to carefully distinguish the two.In addition to Parkinson-like motor symptoms,some non-motor symptoms can run through the entire course of MSA and PD,such as autonomic dysfunction and sleep disorders.Recently,researchers have mostly used autonomic dysfunction as an indicator for the differential diagnosis of MSA and PD.Lower urinary tract dysfunction is one of the most common autonomic dysfunctions,which significantly affects the quality of life and survival of patients,and increases motor dysfunction,and increase the financial burden of individuals and society.Urodynamic examination can accurately reflect the severity of lower urinary tract disorders,and provide objective scientific evidence for the diagnosis,differential diagnosis,treatment,and prognosis of such related diseases.However,there are few studies on the differential diagnosis of MSA and PD by urodynamics.Some studies have only conducted preliminary explorations on the postvoid residua,but the conclusions of the study are quite different.Therefore,this study intends to further summarize and explore the urodynamic characteristics of MS A and PD,in order to find the differences in urodynamic indicators,and provide a powerful guide for the differential diagnosis of the two.MethodsThis study used a retrospective analysis method.The patients who were admitted to the hospital from March 2010 to January 2021 in the First Affiliated Hospital of Zhengzhou University with clinical diagnosis of MSA(177 cases)and PD(158 cases)were collected and divided into MSA group and PD group.According to the standard method recommended by the International Urological Control Association,the urodynamic test is performed with the LABORIE Urodynamic Tester of model AQS2001.Collected general clinical data,urodynamic results and parameters of all patients.Explored the urodynamic characteristics of MSA and PD,calculated the sensitivity and specificity of urodynamic parameters for MSA diagnosis by comparing the difference between MSA and PD urodynamic results,drew out the ROC curve with statistically significant parameters,and find the best cut-off value.At the same time,we also explored the gender differences in urodynamics between the two diseases and conduct gender subgroup analysis.SPSS 21.0 software was used for statistical analysis of the data.Quantitative data were represented by mean ± standard deviation,and qualitative data were represented by frequency and rate.The Kolmogorov-Smirnov test was used to evaluate the normality of distribution,and the Levene test was used to evaluate the homogeneity of variance.the two groups of quantitative data were compared,if they do not conform to the normal distribution,non-parametric test was used;if it conforms to the normality and the homogeneity of variance,the independent sample t test was used;if the variances were not uniform,the t’ test was used.Qualitative data used chi-square test or adjusted chi-square test or Fisher’s exact probability method.Graphpad Prism 7.0 software was used to draw receiver operating characteristic curve,and the best cut-off value was calculated according to sensitivity and specificity.P<0.05 indicated that the difference was statistically significant.Results1.Compared with the PD group,the MSA group had shorter course of disease and higher incidence of lower urinary tract symptoms,urinary incontinence and urinary retention;higher incidence of urinary failure,decreased maximum uroflow rate,decreased urine output,decreased average uroflow rate,and increased postvoid residual in Free uroflowmetry(UFM);high incidence of bladder dullness,poor compliance,urination failure,impaired detrusor contractility and detrusor hyperactivity with impaired contractility(DHIC),decreased maximum uroflow rate,decreased urine output,shortened uroflow rate,prolonged urination time,reduced average uroflow rate,and increased postvoid residual in Cystometrography(CMG)and Pressure-flow study(PFS).Compared with the MSA,PD had higher detrusor pressure at maximal uroflow rate(Pdet.max),bladder sensitivity and detrusor overactivity(DO)leakage.The above difference was statistically significant(P<0.05).2.Compared with female MSA,male MSA had higher incidence of urinary retention;higher incidence of urinary failure,decreased maximum uroflow rate,decreased urine output,decreased average uroflow rate,and increased postvoid residual in UFM;higher incidence of poor compliance,DO leakage,outlet obstruction,decreased maximum uroflow rate,decreased urine output,decreased average uroflow rate,and increased postvoid residual in CMG and PFS.The above difference was statistically significant(P<0.05).3.Compared with female PD,male PD had higher incidence of lower urinary tract symptoms,urinary frequency and urgency;,decreased maximum uroflow rate,prolonged time to reach the peak uroflow rate,prolonged uroflow rate time is prolonged,and prolonged urination time,decreased average uroflow rate in UFM;,higher incidence of outlet obstruction,decreased maximum uroflow rate,higher Pdet.max,decreased average uroflow rate in CMG and PFS.The above difference was statistically significant(P<0.05).4.Compared with MSA-P,MSA-C had more difficulty of urination,and the difference was statistically significant(P<0.05).But there was no difference in urodynamic characteristics and parameters between MSA subtypes(P>0.05).5.In the analysis of male and female subgroups,we found that compared with PD,MSA had shorter course of disease and higher incidence of lower urinary tract symptoms,urinary incontinence and urinary retention;higher incidence of urinary failure,decreased maximum urinary flow rate,decreased average uroflow rate,and increased residual urine volume in UFM;higher incidence of bladder dullness,urinary failure,impaired detrusor contractility,DHIC,decreased maximum uroflow rate,decreased urine output,decreased average uroflow rate,and increased postvoid residual in CMG and PFS.Compared with the MSA group,the PD had higher incidence of bladder sensitivity.Only in the analysis of male subgroups,it was found that poor compliance was more in MSA,DO leakage,outlet obstruction and higher Pdet.max were more in PD.The above difference was statistically significant(P<0.05).6.PFS-postvoid residual(cut-off value>186ml,sensitivity of 67.57%,specificity of 79.76%)had the largest AUC value.Followed by UFM-postvoid residual,PFS-urine output,PFS-average uroflow rate,PFS-uroflow rate time,UFMmaximum uroflow rate,UFM-urine output.Conclusion1.Both MS A and PD had lower urinary tract dysfunction.Men were more serious than women.Compared with PD,MSA lower urinary tract dysfunction appeared earlier and more severe.2.There was no significant difference in urodynamic characteristics and parameters between MSA-P and MSA-C,suggesting that the severity of lower urinary tract disorders was similar between MSA subtypes.3.Urodynamic parameters had certain differential diagnosis value for MSA and PD.Among them,PFS-residual urine volume(cut-off value>186ml)had the best diagnostic performance for MSA.