Article

OBJECTIVES: To delineate the frequency, clinical risk factors, and urodynamic
mechanisms of incomplete bladder emptying (IBE) among patients with recent
stroke. DESIGN: Retrospective study. SETTING: Inpatient setting in the
rehabilitation ward of a university hospital. PARTICIPANTS: All patients with
acute stroke admitted for rehabilitation between January and December 2005,
excluding those with a history of lower-urinary tract symptoms and urologic
diseases. Eighty-two patients (42 women and 40 men; mean age, 65.5 y) were
included. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We measured
postvoid residual (PVRs) by catheterization or by using an ultrasonic bladder
scanner. Twenty-five patients (30.5%) had IBE with PVRs greater than 100 mL on 2
consecutive days. Patients with IBE were evaluated by a urologist and
subsequently underwent urodynamic studies. RESULTS: The presence of IBE was
significantly associated with urinary tract infection (P<.001) and aphasia
(P=.046). The presence of IBE was not related to sex, stroke location, nature of
stroke (hemorrhagic or ischemic), history of diabetes mellitus, or previous
stroke. Urodynamic studies done on 22 patients with IBE revealed acontractile
detrusor in 8 patients (36%) and detrusor underactivity in 3 (14%). Eleven
patients (50%) had detrusor-external sphincter dyssynergia (DESD) combined with
normative detrusor function (5 patients) or detrusor hyperactivity (6 patients);
all but 1 of these patients had a supratentorial lesion. The presence of DESD was
associated with a longer onset-to-evaluation interval (P=.008) and spasticity of
the stroke-affected lower limb (P=.002). Diabetes mellitus was associated with
the presence of acontractile detrusor or detrusor underactivity (P=.03).
CONCLUSIONS: IBE is common among patients with stroke and is caused by decreased
detrusor contractility or DESD. Spasticity of the external urethral sphincter is
a possible pathophysiologic mechanism of DESD.
CI - Copyright 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS