S-3-02-01
STUDY OF THE RELATIONSHIP BETWEEN PREMORBID URINARY INCONTINENCE AND STROKE OUTCOME.
Anthony B Ward, Sluiman Jawad, (Keele University, Stoke on Trent, UK)
Urinary incontinence is a valid predictor of poor functional outcome and poor survival following stroke-1,2. It is, along with stroke, common in elderly populations and has a multi-factorial basis-3. In addition, it correlates with moderate and severe motor deficit, impaired mobility and mental impairment-1. The reporting of pre-morbid incontinence in stroke populations has varied from 3-17%-1,2 and it is thus important to know if this condition is as predictive of a poor outcome as patients, who have become incontinent after a first stroke. Realising the implication of post-stroke incontinence, this prospective study compared the functional outcome between continent and premorbidly incontinent groups in stroke patients. 86 patients (37 in each group), age range 47-80 years (mean 68) were studied following a first stroke and were assessed at one week and later at six months. The following assessments were made. Barthel ADL scale, which is validated for functional outcome at six and twelve months, Hodkinson score for orientation, continence status, determined from direct questioning and the clinical notes and co-morbidity. 37.5% of those who survived to six months were incontinent and age and incontinence were found to be the most statistically significant variables. Among the 19 who died, 14 were incontinent and had been incontinent for a longer time than others in the group. A significant association has been found between age, incontinence and stroke outcome on the Barthel scale (p=0.002 and 0.001 respectively). It is possible that ischaemia to the neuromicturition pathway in the frontal lobes may explain why premorbidly incontinent patients carry a greater risk of poor recovery.
1. Wade DT, Wood VA, Langton Hewer R. JNNP. 1984; 48: 7-13.
2. Borrie MJ, Campbell AJ, Caradoc Davies TH, et al. Age & Ageing. 1986; 15: 177-181.
3. Gardner J, Fonda D. Disabil & Rehab. 1994; 16(3): 140-48.
S-3-02-02
NEUROGENIC BLADDER IN STROKE
Eiji Iwatsubo (Labor Welfare Corporation Spinal Injuries Center, Iizuka, Japan)
Urinary disturbance several days or weeks of stroke is mainly urinary retention, resulting in dysuria, urgency or urinary incontinence. Urodynamic study explains pathognomonic situation of these symptoms. (Material & method) 24 cases of chronic hemiplegic male from stroke, age 60-82 (av. 66) y/o were refereed for urological assessment in past 10 years and their urodynamic findings were studied concerning cystometric type and voiding function. (Results) Seventy per cent of them had hyper-reflex bladder contraction, 40 % had urinary incontinence, 30 % had residual urine over 50ml and 40 % had urinary infection. Seven patients had been accompanied by prostatic hypertrophy. In 6 patients urinary incontinence was controlled or improved with medication or clean intermittent catheterization. (Conclusion) Urodynamic evaluation is mandatory to evaluate who is curable or not with pathognomonic treatment.
