Urinary Incontinence in Acute Stroke: A Clinical and Urodynamic Evaluation

Abstract

Previous investigators have suggested that poststroke urinary incontinence is most often due to disruption of the neuromicturation pathways which results in bladder hyperreflexia, as a second cause cognitive impairment and language deficits related to stroke, and as third cause detrusor hyporeflexia resulting overflow incontinence. This study was planned to evaluate relations among poststroke urinary incontinence and urodynamic findings, neurological findings, lesion type, lesion locations, functionaldisability, and cognitive state. Comparison of the clinical features of the patients with urinary incontinence and without incontinence was also our aim. 38 acute stroke patients who have not previous stroke, previous urinary incontinence and additional urinary pathology were investigated. Urodynamic studies were performed on 22 acute stroke patients with urinary incontinence within 10 days after stroke and their clinical features were compared to the clinical features of 16 acute stroke patients without incontinence. Cranial CT, Mini Mental State scores, Barthel Index scores was obtained for all patients and neurologic examination was performed. When 22 patients with incontinence were compared with 16 patients with continence, features related to the lesion on CTwere not found significantly different. Barthel Index scores were found different (p=0,001). Urodynamic studies revealed bladder hyperreflexia in 81%, bladder hyporeflexia in 4,5%, normal studies in 13% of the incontinent patients. There was o negative correlation between age and bladder compliance whereas no relation were found Barthel Index scores, Mini Mental Status examination and degree of extremity paresis. The mean age of the patients who had hyperreflexic bladder was higher than the patients who had normal bladder (p=0,029) but there was no significant difference for the features of lesions on CT. It will he useful the evaluation of the features of incontinence after stroke and clinical features of the patients as a combination because treatment strategies may differ depending on the type of incontinence.