Clinical findings that may be clues to the presence of MSA:
(1) Parkinson-like symptoms
(2) one or more of the following:
(2a) onset of urinary symptoms before or concurrent with the onset of Parkinson-like symptoms
(2b) onset of erectile dysfunction before or concurrent with the onset of Parkinson-like symptoms
(2c) bothersome urinary incontinence
(2d) a large post-void residual urine volume
where:
• A patient with Parkinson's disease often has the onset of genitourinary symptoms after the onset of neurologic symptoms. The patient is also less likely to have bothersome urinary incontinence or a large post-void residual urine volume.
• Common urinary symptoms are: difficulty voiding, nocturnal urinary frequency, sense of urgency, urge incontinence, enuresis, and urinary retention.
A patient with MSA tends to have worse bladder control after urological surgery. Medical management is usually preferred for these patients.
