Predicting Incomplete Voiding in Multiple System Atrophy Using a Questionnaire

ABSTRACT Background A postvoid urinary residual (PVR) volume of ≥ 100 mL has been included as evidence of autonomic dysfunction in the 2022 Diagnostic Criteria for Multiple System Atrophy (MSA) and has also been generally accepted as a sufficient indication for starting self‐intermittent catheterization or indwelling urinary catheterization. Aim This study aimed to determine whether a questionnaire can predict a PVR volume of 100 mL in patients with MSA. Methods A total of 80 patients with MSA were included. Scores on overactive bladder and voiding symptoms obtained from a patient‐completed questionnaire were then evaluated for their correlation with PVR volume. Moreover, the ability of the scores to predict a PVR volume of ≥ 100 mL was assessed using receiver operating characteristic curve analyses. Results A PVR volume of ≥ 100 mL was less frequently found in female than in male patients with MSA (17.1% vs. 41.0%; p = 0.018). Scores related to voiding difficulty correlated well with PVR volume and showed good diagnostic performance in identifying PVR volume of ≥ 100 mL. In particular, the urinary hesitancy quality of life (QOL) score obtained from a single simple question showed the highest correlation with PVR volume. However, some patients with a PVR volume of ≥ 100 mL had no or subtle symptoms of distress when voiding. The association between PVR volume and voiding symptoms was weaker in female than in male patients. Conclusions Voiding questionnaire scores could be used in identifying a PVR volume of ≥ 100 mL in patients with MSA, particularly male patients.