Lower urinary tract dysfunction is a common sequela of ischemic stroke. More than 1/3 stroke patients are hospitalized, and as many as 1/4 of them still have urinary incontinence one year later. Urinary incontinence after stroke is a powerful predictor of higher mortality, higher degree of hospitalization, and higher degree of disability. The purpose of this study was to study the urodynamic manifestations of lower urinary tract dysfunction before and after clinical intervention in patients with ischemic stroke.

The data of 50 patients with lower urinary tract dysfunction after ischemic stroke who underwent urodynamic examination in the Hospital from January 2020 to January 2022 were analyzed. All patients met the diagnostic criteria of ischemic stroke. Exclusion criteria: urinary and nervous system diseases affecting voiding function. The patients were divided into pre-treatment group and post-treatment group, and the maximum urinary flow rate, micturition volume and bladder residual urine volume were compared between the two groups. The bladder function of the patients was evaluated and the characteristics of urodynamic examination were analyzed. The patients with detrusor hyperactivity were treated with tolterodine, those without detrusor reflex were given clean intermittent catheterization, and those with suspected bladder outlet obstruction were treated with tamsulosin. The curative effect, urodynamic performance and patient satisfaction after intervention were observed.

Before clinical intervention, 50 patients (36 males and 14 females, with an average age of 69 years), 31 cases of detrusor hyperactivity (62.0%), 6 cases of detrusor contraction weakening (12.0%), 9 cases of detrusor non-reflex (18.0%), no detrusor-urethral sphincter coordination disorder. The maximum urinary flow rate, micturition volume, bladder residual urine volume, maximum detrusor systolic pressure and maximum bladder capacity were (9.63 ±2.85) ml/s, (126.81 ±11.47) ml, (111.83 ±10.47) ml, (57.02 ±3.55) cmH2O, (260.65 ±12.51) ml, respectively. The maximum urinary flow rate, micturition volume, maximum detrusor systolic pressure and maximum bladder volume in patients with lower urinary tract dysfunction after ischemic stroke were significantly lower than the normal value, while the bladder residual urine volume was significantly higher than the normal value (all P < 0.05). After 3 months of clinical intervention, the maximum urinary flow rate, voiding volume and bladder residual urine volume were (12.25 ±2.38) ml/s, (145.31 ±12.20) ml and (90.53 ±10.22) ml respectively. The average QOL score after 3 months treatment was 3.0 ±0.5, which was significantly higher than that before intervention (P < 0.01).

Ischemic stroke causes up to 60% of patients with bladder dysfunction, and most of the lower urinary tract symptoms caused by stroke are overactive bladder (urgent urination and frequent urination)1. Compared with previous literature, this study compared the urodynamic performance of ischemic stroke patients with lower urinary tract dysfunction before and after treatment, as well as the QOL score before and after treatment, to evaluate the therapeutic effect more scientifically and comprehensively.The urodynamic characteristics of bladder function in patients with lower urinary tract dysfunction after ischemic stroke are mainly characterized by detrusor hyperreflexia, which may be due to the damage of cerebral detrusor center or its conductive fibers. Detrusor weakness may occur in a few cases, and its mechanism is unclear, which may be related to some nerve damage with unknown function. The maximum urinary flow rate and micturition volume were significantly lower than the normal reference value, while the bladder residual urine volume was significantly higher than the normal reference value, which were improved after clinical intervention. It is suggested that urodynamic guidance for treatment and follow-up has significant advantages.

The main manifestation of lower urinary tract dysfunction in ischemic stroke is the high incidence of detrusor overactivity, and a few patients may have detrusor weakness or even no reflex. The urodynamic performance was significantly improved after clinical intervention. Urodynamics can guide clinical treatment and improve the quality of life of patients.

Tateno F, Sakakibara R, Aiba Y, et al. Bladder Autonomic Dysfunction after a Parietal Stroke. J Stroke Cerebrovasc Dis. 2020. 29(4): 104620.