Brain imaging and urodynamic correlation in patients with cerebrovascular stroke

Objective: To identify urodynamic abnormalities in patients with cerebrovascular accidents and correlate both with CT or MRI findings. Patients and Methods: From September 2001 to March 2003; a total of 44 males and 16 females were prospectively examined urodynamically in different phases after cerebrovascular accidents; and as early as two days after stroke. Results: In most cases; the urodynamic findings could be correlated with CT or MRI findings. The most determining factor was the site of the lesion followed by the size. Small lesions were frequently silent unless located in critical sites. It was found that frontal; frontoparietal; parietal; basal ganglia and internal capsular ischemic lesions were associated in most cases with detrusor hyperreflexia; whereas thalamic; pontine and cerebellar infarcts were linked to detrusor hyporeflexia. Multiple lesions within the same group produced the same effect; while mixed lesions produced variable ef-fects. There was no effect of laterality or dominance and an initial shock phase could not be identified. Detrusor-sphincter-dys-synergia (DSD) and hence upper tract deterioration were not observed. The effect of stroke was also modified by already present or predominant conditions such as BPH. Conclusion: Correlating urodynamic and CT findings is very difficult in stroke patients because of the diffuse nature of the lesions; the unknown function of many brain centers in micturition control; the innumerable connections between the different brain regions and the extremely complicated influences that the brain regions exert upon each other and upon the bladder. The optimal understanding of the problem is dependent upon the better understanding of the function of each part of the brain. Further studies in this direction are recommended

Intravenous urography versus sonography plus kub film in the investigation of lower urinary tract symptoms

To compare abdominal ultrasonography plus KUB film versus intravenous urography [IVU] in the investigation of lower urinary tract symptoms [LUTS]. Retrospective study in which analysis of the radiological data from the files of patients presented with LUTS in the last 2 years [228 patients with only 184 had been fully evaluated]. Those patients had been already investigated and/or operated upon. Clinical urological examination, urine analysis, culture and sensitivity, urine cytology, cystoscopy, urodynamic studies, and transrectal ultrasonography were relevant details to the study. To measure the sensitivity and specificity of ultrasonography plus KUB film compared with IVU positive findings for the diagnosis of patients with LUTS. Important abnormalities were seen in 124 of 184 fully evaluated patients, the most common being a poorly emptying bladder [46]. The combination of KUB and ultrasonography detected more abnormalities than IVU alone. Only two important abnormalities were missed by this combination [sensitivity 91% and specificity 100%]. Ultrasonography plus KUB film is as accurate as IVU in detecting important urological anatomical abnormalities in patients presenting with LUTS. This combination is safer than IVU and should be the initial investigation for such patients. Flowmetry is useful for the assessment of an incompletely emptying bladder. Additional cystoscopy was very important for the diagnosis of bilharzial cystitis, ulcer bladder, interstitial cystitis, carcinoma in situ [CIS] and small bladder tumors all of which was neither diagnosed by IVU nor ultrasonography