A Descriptive study on Urodynamic Abnormalities in Stroke patients after Acute Phase.

INTRODUCTION : Cerebrovascular accident (CVA) is a serious neurologic event and, depending on the extent, a CVA can have temporary or permanent effects on survivors including deficits in speech, vision, memory, cognition, motor and sensory function, and volitional control of voiding. Stroke accounts for more than 40% of acute admissions in a neurological centre. Following a stroke, 10% of the survivors, recover completely, 80% to varying levels and 10% need institutional care due to severe disability.1 For the middle 80%, stroke rehabilitation by a rehabilitation team can significantly improve functional ability. Poor prognostic indicators of outcome are, previous stroke, older age, bladder and bowel incontinence and visuospatial deficits. AIMS AND OBJECTIVES : 1. To determine the incidence of voiding abnormalities due to bladder dysfunction in MCA stroke patients, subsequent to the acute sickness phase. 2. To describe the urodynamic abnormalities by using cystometry, in the above patients. MATERIALS AND METHODS : Patients for this study were selected from post stroke patients attending the outpatient clinics of department of Physical Medicine and Rehabilitation, and OPDs of Department of Medicine of CMC Hospital, and also from the medical OP of the Government Pentland Hospital, Vellore between January 1999 to May 2001. Study was conducted in Department of Physical Medicine and Rehabilitation, CMCH, Vellore, in collaboration with Urology Unit II. A total number of 20 patients were included in the study. This study was presented to the Research Committee for approval and ethical clearance, which were obtained. Inclusion criteria were: 1. Patients between 25-65 years of age. 2. Patients who have completed three weeks, but within three months, of onset of cerebrovascular accident in the middle cerebral arterial territory of either side. 3. Patients not having any pre-existing urinary complaint. 4. Patients who have had imaging, to confirm the site of the cerebrovascular accident. Exclusion criteria were: 1. Patients with abnormal renal function, as indicated by elevated serum creatinine. 2. Patients with history of previous strokes. 3. Patients having an unstable general condition or aphasia or poor cognition status or those who were moribund. 4. Patients with a history of epilepsy, metabolic encephalopathy or prior brain trauma or surgery of any region of the brain. 5. Patients with symptomatic, lower urinary tract infection. RESULTS : 20 patients with post stroke for 3 weeks to 3 months were selected to observe the voiding pattern and urodynamic parameters. There were 17 males and 3 females in this group and their age ranged from 34 - 65 years. Study design: Prospective descriptive study. A standardised proforma was used to enter patient data. CONCLUSION : Voiding dysfunction following cerebro vascular accident is certainly multi factorial. The symptomatology may be same for different types of dysfunctions. Proper diagnosis of the cause and appropriate management of voiding dysfunction in the post stroke patient before the patient leaves the acute care facility is desirable because urinary dysfunction may complicate patient rehabilitation. In this institution we find that the average duration of acute care admission for strokes, is about a week. Our study, although performed on a select population reveals that detrusor hyperreflexia accounts for the large percentage of urinary bladder dysfunction in post stroke patients. The incidence of incontinence, which is supposed to be a bad prognosticator, was 40%. Detrusor hyperreflexia is the major factor to cause incontinence, if not suppressed. Anti cholinergic agents for the treatment of detrusor, hyperreflexia have the potential to cause urinary retention