Classification and Clinical Characteristics of Urinary Disturbances in Acute States of Stroke

• Published in: Rihabiritēshon igaku Vol. 35; no. 8; pp. 549 - 555
• Main Authors: ITOH, Motoya, OSHIDA, Naoko, TOYOTA, Akihiro, ITOH, Hideki, SHIOI, Miki, NAKAMURA, Kayo, HAGINAKA, Takahiro
• Format: Journal Article
• Language: English
• Published: The Japanese Association of Rehabilitation Medicine 1998
• Subjects: acute phase rehabilitation; cerebrovascular disease; urinary disturbances; urodynamic study
• ISSN: 0034-351X; 1880-778X
• DOI: 10.2490/jjrm1963.35.549

In this study, we investigated the characteristics of urinary disturbances in acute states of stroke and evaluated the treatment methods. The subjects were 148 patients who were admitted on the day of onset of stroke. Age at admission ranged from 25 to 88 years old (mean±SD: 66.6±12.4), and 98 subjects were male and 50 female. Of these patients, 97 demonstrated cerebral infarction, and the remaining 51 demonstrated intracerebral hemorrhage. The severity of urinary disturbances was classified into 4 types by urodynamic study and managing method of the urinary tract: I, II, IIIa and IIIb. Type I patients had no urinary disturbances. Type II patients had a balloon catheter inserted into the bladder, but subsequently did not require medication for urinary disturbances. Type IIIa patients and type IIIb patients were treated by insertion of a balloon catheter into the bladder, and also required treatment for urinary disturbances. Type IIIa patients demonstrated dysfunction of the detrusor muscle and type IIIb demonstrated detrusor-sphincter dyssynergia. All patients were classified into 4 types and were examined regarding the relationship between the severity of urinary disturbances and their sex, age, symptoms on admission and type and location of cerebrovascular disease. Eighty-three patients were classified as type I, 31 as type II, 25 as type IIIa and 9 as type IIIb. The motor functional level of the lower limbs on admission was evaluated using Brunnstrom's staging. The findings were as follows: 1. Type I was observed in 65 (66.3%) of male patients, and in 18 (36.0%) female patients. Type I was also observed in 51 (66.2%) of 77 patients under 65 years old age, and in 32 (45.1%) of 71 patients 65 years or more. Type I was observed more frequently in male than in female patients [p<0.001: x2 test], and in patients under 65 years of age [p<0.01]. 2. Type III was observed in 17 (34.0%) female patients, and in 17 (17.3%) male patients. Similarly, type III was observed in 22 (31.0%) patients 65 years or more, and in 16 (15.6%) under 65 years of age. Type III was observed more frequently in female patients [p<0.05], and in patients 65 years or more [p<0.05]. All type IIIb patients were 70 years or more. 3. Type III was observed more frequently in patients with severe cerebral infarction and intracerebral hemorrhage. 4. Patients with a balloon catheter inserted into the bladder were those with consciousness impairment (CI), deep sensory disturbance and anosognosia (AG) on admission [p<0.01: multivariate analysis]. Type III patients were those with CI [p<0.01] and AG [p<0.05] on admission. Therefore, there was a marked correlation between the severity of urinary disturbances and the sex, age of patients and their symptoms in the acute state of stroke.