Objective: We describe 6 cases of probable MSA presenting with urinary retention/incomplete bladder emptying.

Background: MSA is a progressive neurodegenerative adult-onset disease whose clinical features include autonomic failure, cerebellar dysfunction, parkinsonism and corticospinal disorders in various combinations (1). Urinary dysfunction may be the presenting symptom in patients with MSA and it is more common and often an earlier manifestation than orthostatic hypotension (2). The prevalence of incomplete emptying/urinary retention in MSA appears to be time-dependent and usually becomes evident from the second year of illness (2). However urinary retention as a presenting complaint is rare.

Methods: We present a series of 6 patients with probable MSA presenting initially with incomplete bladder emptying/urinary retention and erectile dysfunction which predated the occurrence of any motor or cardiovascular autonomic symptom. The anal sphincter EMG was abnormal when carried out. On follow-up the patients developed extrapyramidal and/or cerebellar symptoms and autonomic failure and received a diagnosis of probable MSA. The mean interval between onset of bladder dysfunction and presentation to a Neurologist was 4.6 years (SD 3.03).

Results: Urinary retention may be the presenting feature in patients with MSA and may long predate the other clinical symptoms. In male patients erectile dysfunction is often an early accompanying feature. A structural cause for urinary retention had been excluded. The presence of concomitant sexual and bowel dysfunction and abnormal anal sphincter EMG may suggest that the disease process started in the sacral spinal cord in this subset of patients.

Conclusions: A subset of patients with probable MSA present with urinary retention and in view of an abnormal anal sphincter EMG, the likely onset of disease is the sacral spinal cord.

References: 1) Gilman S, Wenning GK, Low PA, et al. Second consensus statement on the diagnosis of multiple system atrophy. Neurology. 2008;71(9):670-676. doi:10.1212/01.wnl.0000324625.00404.15. 2) Sakakibara R, Tateno F, Yamamoto T, et al. Urological dysfunction in synucleinopathies: epidemiology, pathophysiology and management. Clinical autonomic research. 2018 Feb;28(1):83-101. doi: 10.1007/s10286-017-0480-0.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/probable-msa-presenting-initially-with-urinary-retention/