Acute ischemic cerebrovascular accident and new onset voiding dysfunction: a prospective correlation of CT findings with urodynamic findings

ABSTRACT

New onset voiding dysfunction after a stroke is a difficult problem for all persons involved in the care of those patients. We evaluated the effects of an acute cerebrovascular accident on the lower urinary tract and correlated the site, size and side of cerebrovascular accident with the urodynamic findings. This study included 103 patients [56 males and 47 females] with acute cerebrovascular accident from September 2001 to August 2003. All patients with disturbance of conscious level or mental changes or previous history of stroke were excluded from the study, The included patients were assessed neurologically and urologically. Computerized Tomography [CT] was done for all patients. A total of 56 patients underwent urodynamic study with electromyography within one week of cerebrovascular accident. Patients were divided into 5 different groups based on urodynamic findings. 59.2% of the patients had urinary.symptoms and the most common symptom was incontinence [42.6%], followed by retention [41%]. We found a correlation between voiding disturbance with hemiparesis [P<0.01], not with hemianopia. Urodynamic studies of 56 patients revealed that 31 patients [55.4%] had detrusor hyperreflexia and 17 patients [39.1] had detrusor areflexia. The majority of the lesions responsible for detrusor hyperreflexia were from frontoparietal region and internal capsule whereas thalamic, pontine and cerebelluar lesions were associated more with detrusor hyporeflexia. There was no effect of laterality or dominance on the urinary symptoms or urodynamic findings: