Analysis of the relationship between urinary symptoms and the topography of brain injury in stroke patients
DOI:
https://doi.org/10.15448/1983-652X.2018.1.26335Keywords:
stroke, urination disorders, brain injuries.Abstract
Objective: This study analyzed the relation between brain injury topography and bladder dysfunction in patients with ischemic and hemorrhagic stroke by comparing the brain region affected with lower urinary tract symptoms (LUTS).
Material and Methods: A retrospective study developed by the SARAH Network of Rehabilitation Hospitals in Brazil, involving 132 patients with chronic stroke attended by an adult neurological rehabilitation program, from January 2008 to December 2011.
Results: 106 patients (80.3%) showed ischemic stroke sequelae and 26 (19.7%) hemorrhagic stroke sequelae. Patient mean age was 56.0±13.1 years and the mean period since stroke occurrence was 21.4 months. Regarding voiding behavior, 35.6% (n=47) showed bladder continence, 45.5% (n=60) presented LUTS, and 18.9% (n=25) presented continuous urinary incontinence. The presence of continuous urinary incontinence was significantly associated with extensive lesions in the frontal-parietal-temporal-occipital regions (p=0.001), cognitive deficits (p=0.001) and aphasia (p=0.001). In patients with frontoparietal lesions, associations were observed for urgency (p=0.05), urge urinary incontinence (p=0.042), urinary incontinence (p=0.019) and pollakisuria (p=0.042).
Conclusion: Data showed that cognitive impairment and aphasia were correlated with continuous urinary incontinence. Regarding brain injury topography, associations were determined between lesions to the frontal-parietal region and symptoms of urgency, urge urinary incontinence, stress urinary incontinence and pollakisuria, while extensive brain injury was associated with continuous urinary incontinence.
References
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, Elkind MS, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL, Vinters HV; American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; Council on Nutrition, Physical Activity and Metabolism. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44(7):2064-89. https://doi.org/10.1161/STR.0b013e318296aeca
Natsume O. Detrusor contractility and overactive bladder in patients with cerebrovascular accident. Int J Urol. 2008;15(6):505-10.
https://doi.org/10.1111/j.1442-2042.2008.02045.x
Han KS, Heo SH, Lee SJ, Jeon SH, Yoo KH. Comparison of urodynamics between ischemic and hemorrhagic stroke patients: can we suggest the category of urinary dysfunction in patients with cerebrovascular accident according to type of stroke? Neurourol Urodyn. 2010;29(3):387-90. https://doi.org/10.1002/nau.20708
Brittain KR, Perry SI, Peet SM, Shaw C, Dallosso H, Assassa RP, Williams K, Jagger C, Potter JF, Castleden CM. Prevalence and impact of urinary symptoms among community-dwelling stroke survivors. Stroke. 2000;31(4):886-91. https://doi.org/10.1161/01.STR.31.4.886
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A; Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function. Neurourol Urodyn. 2002;21(2):167-78. https://doi.org/10.1002/nau.10052
Fowler CJ. Neurological disorders of micturition and their treatment. Brain. 1999;122(Pt 7):1213-31. https://doi.org/10.1093/brain/122.7.1213
Ji Li W, Oh SJ. Management of lower urinary tract dysfunction in patients with neurological disorders. Korean J Urol. 2012 Sep;53(9):583-92. https://doi.org/10.4111/kju.2012.53.9.583
Olsen-Vetland P. Urinary continence after a cerebrovascular accident. Nurs Stand. 2003;17(39):37-41. https://doi.org/10.7748/ns.17.39.37.s46
Pilcher M, MacArthur J. Patient experiences of bladder problems following stroke. Nurs Stand. 2012;26(36):39-46. https://doi.org/10.7748/ns2012.05.26.36.39.c9087
Marques LP, Schneider IJC, Giehl MWC, Antes DL, d'OrsiI E. Fatores demográficos, condições de saúde e hábitos de vida associados à incontinência urinária em idosos de Florianópolis, Santa Catarina. Rev Bras Epidemiol. 2015;18(3):595-606. https://doi.org/10.1590/1980-5497201500030006
Pitangui ACR, Silva RG da, Araújo RC de. Prevalência e impacto da incontinência urinária na qualidade de vida de idosas institucionalizadas. Rev Bras Geriatr Gerontol. 2012;15:619-26. https://doi.org/10.1590/S1809-98232012000400002
Neves RCS. Incidência e fatores de risco de bexiga hiperativa em adultos: resultados de um estudo prospectivo de base populacional [Internet]. 2010 [capturado 2017 Jul 4] Disponível em: http://www.arca.fiocruz.br/handle/icict/4312
Datasus. Classificação estatística internacional de doenças e problemas relacionados à saúde [Internet]. 2008. Disponível em:
http://www.datasus.gov.br/cid10/V2008/cid10.htm
Green JB. Brain reorganization after stroke. Top Stroke Rehabil. 2003; 10(3):1-20. https://doi.org/10.1310/H65X-23HW-QL1G-KTNQ
Scarpa KP, Herrmann V, Palma PCR, Riccetto CLZ, Morais SS. Sintomas urinários irritativos após o parto vaginal ou cesárea. Rev Assoc Med Bras. 2009;55(4):416-20. https://doi.org/10.1590/S0104-42302009000400016
Tanagho EA, Mcaninch JW. Urologia geral de Smith. 16º ed. Barueri: Manole; 2007, 860 p.
Estatuto da criança e do adolescente. Lei nº 8.069, 13 de julho de 1990, e legislação correlate [Internet]. 9ª ed. Biblioteca Digital da Câmara dos Deputados. Central de Documentação e Informação. Coordenação de Biblioteca. 2012. Disponível em: http://bd.camara.gov.br
Cohen JA. A power primer. Psychol Bull. 1992;112(1):155-9. https://doi.org/10.1037/0033-2909.112.1.155
Gupta A, Taly AB, Srivastava A, Thyloth M. Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion? Ann Indian Acad Neurol. 2009 Apr;12(2):104-7. https://doi.org/10.4103/0972-2327.53078
Gelber D, Good D, Laven L, Verhulst S. Causes of urinary incontinence after acute hemispheric stroke. Stroke. 1993;24(3):378-82. https://doi.org/10.1161/01.STR.24.3.378
McKenzie P, Gopal BH. The incidence and etiology of overactive bladder in patients after cerebrovascular accident. Curr Urol Rep. 2012;13(5):402-6. https://doi.org/10.1007/s11934-012-0269-6
Pizzi A, Falsini C, Martini M, Rossetti A M, Verdesca S, Tosto A. Urinary incontinence after ischemic stroke: clinical and urodynamic studies. Neurourol Urodyn. 2014 Apr;33(4):420-5. https://doi.org/10.1002/nau.22420
Sogari P, Dambroa M, Souto CA. Avaliação urodinâmica do homem com obstrução não neurogênica do trato urinário inferior. Rev AMRIGS. 2000;44(34):159-63.
Chen YC, Liao YM, Kuo HC. Lower urinary tract dysfunction in stroke patients. JUTA. 2007;18:147-50.
Ersoz M, Tunc H, Ozel SM. Bladder storage and emptying disorder frequencies in hemorrhagic and ischemic stroke patients with bladder dysfunction. Cerebrovasc Dis. 2005;20(5):395-9. https://doi.org/10.1159/000088670
Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou ECL. Incomplete bladder emptying in patients with stroke: is detrusor external sphincter dyssynergia a potential cause? Arch Phys Med Rehabil. 2010 Jul;91(7):1105-9. https://doi.org/10.1016/j.apmr.2010.03.017
SBU: Sociedade Brasileira de Urologia. Disfunções miccionais em doenças neurológicas:infecciosas-inflamatórias-degenerativas. Brasília: AMB-CFM; 2006.
Sakakibara R, Uchida Y, Ishii K, Kazui H, Hashimoto M, Ishikawa M, Yuasa T, Kishi M, Ogawa E, Tateno F, Uchiyama T, Yamamoto T, Yamanishi T, Terada H; SINPHONI (Study of Idiopathic Normal Pressure Hydrocephalus On Neurological Improvement). Correlation of right frontal hypoperfusion and urinary dysfunction in iNPH: a SPECT study. Neurourol Urodyn. 2012;31(1):50-5. https://doi.org/10.1002/nau.21222
Haines DE. Neurociência fundamental: com aplicações básicas e clínicas. 3ª ed. Rio de Janeiro: Elsevier; 2006, 653 p.
Pettersen R, Haig Y, Nakstad PH, Wyller TB. Subtypes of urinary incontinence after stroke: relation to size and location of cerebrovascular damage. Age Ageing. 2008;37(3):324-7. https://doi.org/10.1093/ageing/afm196
Barata HS, Carvalhal GF. Urologia: princípios e praticas. Porto Alegre: Artmed; 1999.
Zhang H, Reitz A, Kollias S, Summers P, Curt A, Schurch B. An fMRI study of the role of suprapontine brain structures in the voluntary voiding control induced by pelvic floor contraction. Neuroimage. 2005;24(1):174-80. https://doi.org/10.1016/j.neuroimage.2004.08.027
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