Hypothesis / aims of study
Lower urinary tract symptoms (LUTS) associated with stroke is reported to occur 30 to 80% 1). It is a combination of various factors such as lower urinary tract dysfunction (LUTD) (neurogenic bladder) by stroke itself, disorder of urination due to ADL decrease and disorientation (such as functional urinary incontinence), original lower urinary tract disease (prostate hypertrophy, stress urinary incontinence, aging Change, etc.), sequelae associated with urinary tract management (Urinary tract infections, urethral damage, etc.) ,and polydipsia, polyuria and constipation effects. The incidence of lower urinary tract symptoms (LUTS) within 3 months of the entire stroke is reported as 53%, and according to the symptoms, nocturia is most frequent (36%), followed by urge incontinence (29%), but urinary retention was only 29% in the acute phase 2). Furthermore, when the same patient was followed up for 4 to 48 months, LUTS decreased from 53% to 46%, and all cases of urinary retention became possible to urinate 2). In addition, rehabilitation has been reported to reduce urination disorders 3), and ADL levels are greatly involved in performing normal urination actions. X Hospital is a specialized hospital focusing on urology and neurosurgery, and the number of patients with cerebrovascular disease has increased since the establishment of the stroke center, and the number of cases complaining of LUTS has increased. In addition, rehabilitation is started from the day after admission in most cases. In this study, we examined the relationship between ADL and LUTS and changes using routine clinical cases.
Study design, materials and methods
Among stroke patients admitted to X Hospital, 500 cases with history of urinary catheter placement were included. LUTS after urethral catheter removal was classified into four groups: urinary retention, residual urine of over 100ml, urinary incontinence, and normal. LUTS after catheter removal was evaluated every week, the rehabilitation start date was the initial evaluation time (FIRST), and the evaluation date closest to the discharge date was the final evaluation time (LAST). We used the Barthel Index (BI) as an assessment of ADL and examined its association with LUTS. Next, we examined the relationship between BI and LUTS at “FIRST”, at the time of initial catheter removal (NEXT), and at “LAST” focusing on urinary retention cases.
The classification of cases was: cerebral infarction 254 cases (51%), cerebral hemorrhage 174 cases (35%), and subarachnoid hemorrhage 72 cases (14%).LUTS at “NEXT” was 102 cases (20%) of urinary retention, 123 cases (25%) of residual urine over 100ml, and 178 cases (36%) of urinary incontinence, and at “LAST” (n=398) were 29 cases (7%), 41 cases (10%), and 117 cases (29%) (Fig.1). Considering the case of urinary retention at “NEXT”, LUTS at “LAST” (n=73) were 26 cases (36%), 15 cases (21%), and 18 cases (25%). It was possible to remove catheter in 47 cases (64%), and the number of removal was 37 in 2 times, 4 in 3 times, 5 in 4 times. Moreover, only 18 patients (25%) used oral medication. In the cases of no micturition desire at “LAST”, it was possible to urinate in 34 cases (50%). Micturition desire and ADL were compared in the urinary retention group (POOR) and the urinary retention improvement group (GOOD) at “LAST”. While micturition desire in “POOR” was 15% at “NEXT” and 27% at “LAST” (n.s.), micturition desire was significantly improved from 25% to 63% in “GOOD” (p <0.001). Moreover, there were significant differences between the groups (p <0.01). Changes in ADL were examined at “FIRST”, at “NEXT”, and at “LAST” using BI. Significant improvement was observed with 0.8 ± 2.4 points, 6.7 ± 9.6 points (p <0.01), and 9.8 ± 13.5 points (p <0.01) in “POOR”, 1.6 ± 4.3 points, 10.4 ± 14.1 points (p <0.001), and 22.1 ± 23.7 points (p <0.001) in “GOOD”. Moreover, there were significant differences between the groups at “LAST” (p <0.01) (Fig.2).
Interpretation of results
Even without the use of drugs, LUTS improved over time. While it was confirmed that there is a strong association between LUTS and ADL, half of the cases with ADL decline were able to withdraw the catheter.