Hypothesis / aims of study
Lower urinary tract dysfunction (LUTD) is a common neurological complication in chronic brain disorders. These impact a person’s quality of life, mortality, and the person’s caregiver significantly. This study tried to distinguish the characteristic of LUTD from the findings of video-urodynamic studies (VUDS) in patients with chronic brain lesions as cerebrovascular accident (CVA), Parkinson’s disease (PD) and early dementia.
Study design, materials and methods
This study is a single-center, retrospective review of VUDS database for LUTD from 1997 to 2019 (n=8343). Patients with unavailable past medical history, preexisting urological diseases, spinal cord injury or other neurological diseases were excluded. Total 169 patients with chronic brain lesions history and 215 control patients without known brain insult were enrolled. All enrolled cases had comprehensive chart review included brain disorder type, the period from diagnosis to following LUTD, urodynamic parameter and definite diagnosis of LUTD on VUDS finding.
The mean period from brain insult diagnosis to LUTD developed (months) is 61.1 months. Patient with LUTD in non-brain lesion group got higher prevalence of at least one symptom of both storage and voiding (Table.1), while brain lesion group have more severe symptoms (33.1% vs. 2.3% in urge incontinence, p<0.001; and 24.8% vs. 11.6% in retention, p=0.001). Higher rate of detrusor overactivity in brain lesion group (72.2% vs 7.9%, p<0.001), especially spontaneous type DO in female and non-BPO male patient. It also associated with more dysfunctional voiding/poor-relaxed external sphincter (DV/PRES, 41.4% vs 27.4%, p=0.003), and PD cases form the predominant part (60% in PD vs. 31% & 36.7% in CVA and dementia, p= 0.003, respectively). In contrast, more bladder neck dysfunction in control (21.9 vs 47.9%). Patient in brain lesion group had more sensitive bladder as lower volume of full sensation (FS) and urge sensation (US) (Table 2), but only female patient had statistically significant reach in DO subgroup analysis. Brain lesion group female got higher bladder outlet obstruction index (BOOI), poorer voiding efficacy (VE) and larger post-voiding residual volume in DO subgroup.
Interpretation of results
Patient with chronic brain lesion mainly showed more severe neurogenic DO with DV/PRES type, rather than milder severity of idiopathic DO with BND in control cases, and these patient in female had more DHIC pattern. PD patient presented as DV in major BOO type, and dementia had poorer bladder contractility and higher DU rate, may related to profound cognitive dysfunction in these cases.