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Preheat oven to 350°F.
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Brown sausage and onions. Add tomato paste and water. Stir until combined, then simmer for 5 minutes over medium heat.
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Cook noodles according to package instructions. Drain and pour into a lightly greased 13" x 9" casserole dish. Spread sausage and tomato mixture on top. Mix together the sour cream, cream cheese and soup, then pour over meat. Sprinkle with cheese.
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Bake for 30 minutes. Garnish with chopped parsley. Serve immediately. Store covered in refrigerator for up to 5 days.