SO SÁNH ĐẶC ĐIỂM TRIỆU CHỨNG ĐƯỜNG TIẾT NIỆU DƯỚI Ở BỆNH NHÂN TEO NHIỀU HỆ THỐNG VÀ BỆNH PARKINSON GIAI ĐOẠN SỚM

Abstract

Background: Multiple system atrophy (MSA) and Parkinson's disease (PD) have overlapping clinical manifestations and are difficult to distinguish in the early stages. Lower urinary tract dysfunction is a core feature that help differentiate between MSA and PD. However, their role in differentiation in the early stages of the disease remains unclear. Objectives: To determine the value of lower urinary tract symptoms (LUTS) and post-void residual volume (PVR) in distinguishing MSA and early PD. Methods: This is a cross-sectional study comparing lower urinary tract symptoms between two groups of PD patients and MSA patients with disease duration less than 5 years. Lower urinary tract symptoms were evaluated with the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and bladder ultrasound to measure post-void residual volume. Results: There were 32 MSA patients and 51 PD patients with disease duration less than 5 years included in the study. All patients with MSA (32/32) had lower urinary tract symptoms, and this rate in the PD group was 64.7% (33/51). 100% of patients with MSA had storage symptoms with urge incontinence being the most common (93.8%), whereas 68.6% of PD patients had storage symptoms with nocturia being the most common (41.2%) (p<0.001). Voiding symptoms were more common in MSA patients than in PD patients (87.5% vs. 27.5%; p<0.001). Lower urinary tract symptoms had an earlier onset in patients with MSA (p = 0.0257). Post-void residual volume > 100 ml was not found in PD patients but was presented in 28% of MSA patients (p<0.001). At the PVR cutoff of 53 ml, there is a sensitivity of 41.9% and a specificity of 98% for the differential diagnosis of MSA and early PD. Conclusion: Clinical symptoms of the lower urinary tract as well as ultrasound measuring residual urine volume can help differentiate between PD and early stage MSA.