Patterns of Voiding Dysfunction of Stroke Patients during Rehabilitation

OBJECTIVE: The purpose of this study is to evaluate the patterns of voiding dysfunction of stroke patients during rehabilitation. METHOD: We evaluated 53 patients with complaints of voiding dysfunction following the strokes. After the comprehensive history and physical examination, all patients underwent cystometric study and males underwent the transrectal ultrasound. RESULTS: The incidences of detrusor hyperreflexia, detrusor areflexia, and normal finding on the cystometry were 50.9%, 32.1%, and 17.0%, respectively (p<0.05). There was a significantly high incidence of detrusor hyperreflexia in the groups of subcortical lesion, large lesion, and the over 3 months after stroke (p<0.05). However, there was no statistical difference on cystometric findings according to the other characteristics of the stroke such as the age, sex, type of stroke, cognition, aphasia, and diabetes mellitus. The incidences of irritative, obstructive, and mixed symptoms according to the presenting voiding complaints were 49.1%, 32.1%, and 18.9%, respectively (p<0.05). There was no significant statistical difference on the cystometric findings according to the 3 voiding symptom groups as well as none of significant statistical difference on prostate enlargement in males in according to the 3 voiding symptom groups. CONCLUSION: Only with the pattern of voiding, we could not predict the cystometric finding or the presence of bladder outlet obstruction. Thus, we recommend the further studies including cystometry and evaluation of the bladder outlet obstruction for the treatment of voiding dysfunction of stroke patients during rehabilitation.

The Effects of Dilution Volume and Muscle Activity on the Paralysis of Gastrocnemius Muscle of Rabbit after Botulinum Toxin A Injection

OBJECTIVE: To evaluate the effects of botulinum toxin A (BT) dilution volume and post- injection exercise with electrical stimulation on muscle paralysis. METHOD: Eighteen New Zealand white rabbits are randomly assigned to 0.1 ml dilution group, 0.5 ml dilution group or control group. Control group did not receive any injection and 10 units of BT was diluted with 0.1 ml (B1) or 0.5 ml (B5) normal saline and injected to the both gastrocnemius muscles. The right lower limbs of experimental groups did not have any treatment after botulinum toxin A injection (B1C, B5C) and left lower limbs had stretching exercise after injection (B1S, B5S) for 2 hours using the pneumatic kicking machine. Electrical stimulation was also applied to the gastrocnemius muscle with the intensity of 20 mA to 30 mA to evoke plantar flexion of ankle joint. Muscle paralysis effect of BT was evaluated with compound muscle action potential (CMAP) amplitude of gastrocnemius muscle with the sciatic nerve stimulation before and 1 week after injection. RESULTS: There were significant CMAP amplitude decreases in all animals after BT injection. There were significant decreases of CMAP amplitudes in B5 group compared with that of B1 group (p<0.001). Left limbs with stretching exercise and electrical stimulation showed lower CMAP amplitude (p=0.01) compared with right limbs which did not have any treatment after BT injection. CONCLUSION: To maximize muscle paralysis effect of the botulinum toxin A, increasing dilution volume and performing post-injection stretching exercise with electrical stimulation are considered a good strategy.