Incomplete Bladder Emptying in Patients With Stroke: Is Detrusor External Sphincter Dyssynergia a Potential Cause?

• Published in: Archives of physical medicine and rehabilitation Vol. 91; no. 7; pp. 1105 - 1109
• Main Authors: Meng, Nai-Hsin, MD, Lo, Sui-Foon, MD, Chou, Li-Wei, MD, Yang, Pey-Yu, MD, Chang, Chao-Hsian, MD, Chou, Eric Chieh-Lung, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2010; Elsevier
• Subjects: Aged; Aphasia - complications; Biological and medical sciences; Diseases of the osteoarticular system; Female; Hospitals, University; Humans; Male; Medical sciences; Middle Aged; Muscle Contraction; Muscle, Smooth - physiopathology; Nephrology. Urinary tract diseases; Neurology; Physical Medicine and Rehabilitation; Rehabilitation; Retrospective Studies; Stroke; Stroke - complications; Urinary Bladder - physiopathology; Urinary Bladder Diseases - etiology; Urinary Bladder Diseases - physiopathology; Urinary system involvement in other diseases. Miscellaneous; Urinary Tract Infections - complications; Urinary tract. Prostate gland; Urination; Urodynamics; Vascular diseases and vascular malformations of the nervous system; Stroke; incomplete bladder emptying; UTI; DESD; IBE; PVR; cerebrovascular accident; electromyogram; CVA; Urodynamics; postvoid residual; detrusor external sphincter dyssynergia; Rehabilitation; Urination; EMG; urinary tract infection; Human; Nervous system diseases; Urinary system disease; Cardiovascular disease; Urinary tract disease; Cerebral disorder; Vascular disease; Reeducation; Detrusor sphincter dyssynergia; Urinary bladder; Orthopedics; Central nervous system disease; Neurogenic bladder; External; Bladder disease; Neurological disorder; Cerebrovascular disease
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2010.03.017

Abstract Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou EC. Incomplete bladder emptying in patients with stroke: is detrusor external sphincter dyssynergia a potential cause? Objectives To delineate the frequency, clinical risk factors, and urodynamic mechanisms of incomplete bladder emptying (IBE) among patients with recent stroke. Design Retrospective study. Setting Inpatient setting in the rehabilitation ward of a university hospital. Participants All patients with acute stroke admitted for rehabilitation between January and December 2005, excluding those with a history of lower-urinary tract symptoms and urologic diseases. Eighty-two patients (42 women and 40 men; mean age, 65.5y) were included. Interventions Not applicable. Main Outcome Measures We measured postvoid residual (PVRs) by catheterization or by using an ultrasonic bladder scanner. Twenty-five patients (30.5%) had IBE with PVRs greater than 100mL on 2 consecutive days. Patients with IBE were evaluated by a urologist and subsequently underwent urodynamic studies. Results The presence of IBE was significantly associated with urinary tract infection ( P <.001) and aphasia ( P =.046). The presence of IBE was not related to sex, stroke location, nature of stroke (hemorrhagic or ischemic), history of diabetes mellitus, or previous stroke. Urodynamic studies done on 22 patients with IBE revealed acontractile detrusor in 8 patients (36%) and detrusor underactivity in 3 (14%). Eleven patients (50%) had detrusor-external sphincter dyssynergia (DESD) combined with normative detrusor function (5 patients) or detrusor hyperactivity (6 patients); all but 1 of these patients had a supratentorial lesion. The presence of DESD was associated with a longer onset-to-evaluation interval ( P =.008) and spasticity of the stroke-affected lower limb ( P =.002). Diabetes mellitus was associated with the presence of acontractile detrusor or detrusor underactivity ( P =.03). Conclusions IBE is common among patients with stroke and is caused by decreased detrusor contractility or DESD. Spasticity of the external urethral sphincter is a possible pathophysiologic mechanism of DESD.