CLINICAL AND URODYNAMIC EVALUATION OF PATIENTS IN THE POST-RECOVERY PERIOD AFTER CEREBROVASCULAR ACCIDENTS

Abstract

The study included 44 males and 16 females examined prospectively in different phases and as early as 2 days after CVA. They were subjected to full neurologic examination, CT or MRI, careful questionnaire, neurourologic examination, abdominal sonography and eventually videourodynamic assessment. Forty two patients had LUTS. Stroke caused the de novo appearance of symptoms in 30%, provoked latent disorders in 16%, caused worsening of symptoms in 10% and did not change the already existing symptoms in 13% of cases. The

, symptoms were irritative in 20 cases, obstructive in 12, mixed in 4 patients. Simple frequency with nocturnal enuresis was found in 5 patients and I patient had a special symptom in form of habitual frequent micturition. Retention was observed in 5 cases, 2 of whom had stroke-induced hyporeflexia and 3 had BPH. Incontinence was present in 26 patients, 9 of whom had preexisting incontinence. The incontinence was urge incontinence in 21, urge-stress in I, and overflow in 4 cases. Patients with TIAs did not develop new symptoms after stroke. Abdominal sonography did not reveal evidence of obstruction in any of our patients. Urodynamic examination revealed that bladder sensation was intact in all patients. Detrusor hyperreflexia was the commonest cystometric finding being observed in 19 patients, 2 of whom were due to a cause other than stroke. Regarding the sphincteric behavior, 5 patients showed uninhibited sphincter

relaxation, 9 patients showed pseudodyssynergia and none of our patients showed

DSD.

The patients fitted into one of the following urodynamic groups according to the behavior of both the bladder and the sphincter: normal bladder with normal sphincter (24 patients), hyperactive bladder with normal sphincter (14 patients), hyperactive bladder with uninhibited sphincter relaxation (5 patients), hypoactive or inactive bladder (8 patients) and BPH (9 patients). Significant residual urine was found in 15 patients and was due to BPH in 9 cases, stroke-induced hyporeflexia in 4 patients, pre-existing LMNL in one case and as a side effect of anticholinergic administration in I case. Obstruction due to BPH was found in 9 cases.