Introduction Cardiovascular autonomic failure is the hallmark finding in Pure autonomic failure (PAF) however other autonomic functions are likely to be affected. This study aims to characterise genitourinary dysfunction in PAF patients and explore their relationship with cardiovascular autonomic dysfunction.

Methods PAF patients who underwent cardiovascular autonomic testing completed self-administered questionnaires evaluating urinary and sexual symptoms and a 3-day bladder diary measuring fluid intake and urine output. Demographic, clinical features, disease duration and related medical comorbidities were assessed.

Results 25 PAF patients (10 males) were recruited (mean age 71+8 years; disease duration 13+8 years). 96% (24/25) reported lower urinary tract symptoms, most commonly overactive bladder symptoms (92%) followed by low stream (80%) and stress incontinence (52%). 4(16%) patients required catheterisation. 19/22 (86%) had nocturnal polyuria (NP), defined as NP index >0.3 (nocturnal urine volume/24-hour urine volume), mean NP index 0.45 (range, 0.20-0.73). There were no significant correlations between BP drops on head-up tilt, supine hypertension, respiratory sinus arrhythmia, Valsalva ratio or disease duration with the degree of nocturnal polyuria and need for catheterisation (p>0.05).

Conclusions NP and genitourinary symptoms are common in PAF. The pathophysiology of NP in PAF is likely to be multifactorial and may not only be explained by cardiovascular autonomic failure.