Incomplete Bladder Emptying in Patients With Stroke: Is Detrusor External Sphincter Dyssynergia a Potential Cause?

Meng, Nai‐Hsin; Lo, Sui-Foon; Chou, Li-Wei; Yang, Pey-Yu; Chang, Chao-Hsian; Chou, Eric Chieh-Lung

doi:10.1016/j.apmr.2010.03.017

Cited by 28 publications

(22 citation statements)

References 20 publications

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“…Observamos que na ocorrência de lesões extensas o comportamento miccional foi alterado, ocasionando diferentes tipos de sintomas e em alguns casos a incontinência urinária contínua. Resultados semelhantes foram encontrados por outros autores que relacionam a presença de afasia e alterações cognitivas à incontinência urinária 21,26 . Tais resultados são condizentes quando correlacionamos com a literatura em relação à fisiopatologia neuro-miccional, em que lesões em lobo frontal desencadeiam urgência, polaciúria e urgeincontinência 27 , também demonstrados em estudos realizados através de SPECT, ao avaliar indivíduos com distúrbios cognitivos, nos quais também houve uma diminuição significativa na atividade do córtex frontal direito relacionado à disfunção urinária 28. No lobo parietal encontra-se o córtex somatossensorial primário, que representa, dentre várias partes do corpo, a pelve e genitálias e, lesões nessa área resultam em alterações na percepção sensorial.…”

Section: Discussionunclassified

“…Em lesões extensas acometendo área frontal a occipital, houve significância estatística para a presença de incontinência urinária contínua. Múltiplas áreas de lesão são relacionadas com déficits motores importantes, alterações cognitivas, comportamentais e de linguagem, assim como na influência direta do comportamento miccional desses pacientes 26 . Ocorre aumento significativo da atividade no giro frontal superior direito e medial esquerdo, giro parietal e giro do cíngulo na presença de disfunção urinária grave, quando comparado pacientes com sequelas neurológicas importantes com aqueles que apresentam sintomas leves 6 .…”

Section: Artigo Originalunclassified

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Análise da relação entre sintomas urinários e topografia da lesão cerebral em pacientes com acidente vascular cerebral

Banaszeski¹,

Christo

2018

Cienc. Saude

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Observou-se que na ocorrência de lesões extensas acometendo a área frontal-parietal-temporal-occiptal (p=0,001), alterações cognitivas (p=0,001) e afasia (p=0,001) houve relação estatística significativa com a presença de incontinência urinária contínua nestes pacientes. Nos pacientes com lesão fronto-parietal houve associação com o sintoma urgência (p=0,050), urgeincontinência urinária (p=0,042), incontinência urinária de esforço (p=0,019) e polaciúria (p=0,042). Conclusão: Segundo a amostra estudada, observamos que alterações cognitivas e afasia tiveram correlação com a incontinência urinária contínua. Em relação a topografia de lesão cerebral houve associação entre lesões em região fronto-parietal com os sintomas de urgência, urgeincontinência, incontinência de esforço e polaciúria; e na ocorrência de lesão cerebral extensa houve prevalência de incontinência urinária contínua.Palavras-chave: acidente vascular cerebral; transtornos urinários; lesões cerebrais. 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

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Section: Discussionunclassified

Section: Artigo Originalunclassified

Análise da relação entre sintomas urinários e topografia da lesão cerebral em pacientes com acidente vascular cerebral

Banaszeski¹,

Christo

2018

Cienc. Saude

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“…Therefore, application of sacral neuromodulation in patients with Fowler’s syndrome may restore normal voiding [20]. Patients with stroke and incomplete bladder emptying might also develop DU due to spasticity of the external sphincter [21]. In young men with LUTS, BND, PRES, and DU are the main urodynamic abnormalities [8,22].…”

Section: Discussionmentioning

confidence: 99%

Video-urodynamic characteristics of non-neurogenic, idiopathic underactive bladder in men – A comparison of men with normal tracing and bladder outlet obstruction

Jiang

Kuo

2017

PLoS ONE

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ObjectiveUnderactive bladder is frequently encountered in elderly patients. It may result from detrusor underactivity (DU) or low detrusor contractility due to a urethral sphincter inhibitory effect. This study analyzed the video-urodynamic study (VUDS) characteristics of patients with underactive bladder in a large cohort of men with lower urinary tract symptoms (LUTS).MethodsMale patients with LUTS who had failed the initial treatment were consecutively enrolled. All patients underwent detailed urological investigations including prostate measurement, free uroflowmetry, post-void residual volume (PVR) measurement, cystoscopy and VUDS. The VUDS characteristics of the men with underactive bladder were analyzed and compared with those of men with bladder outlet obstruction and normal tracing.ResultsA total of 1329 men who underwent VUDS were included in this retrospective analysis. After VUDS, the final diagnosis was DU in 165 patients, poor relaxation of external sphincter (PRES) in 525, bladder outlet obstruction in 501, and normal tracing in 138. VUDS findings in DU patients showed a slowly increased detrusor pressure, intermittent detrusor contractions, or early decline of detrusor contraction, resulting in a low maximum flow rate (Qmax), and large PVR. In comparison with the PRES groups, DU patients were older, had reduced bladder sensation, lower detrusor pressure (Pdet), lower Qmax, larger PVR volume, and lower voiding efficiency. Patients with urodynamic PRES also had low-pressure–low-flow tracings, but their bladder sensation was similar to that with normal tracing. DU patients with very low Pdet also had low detrusor tonicity, and more medical co-morbidities than the other groups did.ConclusionIdiopathic underactive bladder in elderly men could be attributed to urodynamic DU and PRES. DU is associated with old age, reduced bladder sensation, low voiding efficiency, and medical co-morbidities.

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“…In addition, patients with CVA or PD have impaired detrusor contractility or detrusor underactivity resulting in increased PVR volumes [19], [20]. Urethral sphincter dyssynergia, poor relaxation of the external urethral sphincter, and poor relaxation of the pelvic floor muscles are associated with DO in patients with CVA and PD [21]. Anticholinergic treatment of OAB among patients with CNS lesions could cause CNS adverse events and impaired bladder emptying.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Intravesical OnabotulinumtoxinA Injection on Elderly Patients with Chronic Central Nervous System Lesions and Overactive Bladder

2014

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PurposeIntravesical injection of onabotulinumtoxinA is an effective treatment for overactive bladder (OAB). Nonetheless, the treatment outcome is unclear in OAB patients with central nervous system (CNS) lesions. This study evaluated the efficacy and safety of intravesical onabotulinumtoxinA treatment in elderly patients with chronic cerebrovascular accidents (CVAs), Parkinson’s disease (PD) and dementia.Materials and MethodsPatients with CVA, PD, dementia, and OAB refractory to antimuscarinic therapy were consecutively enrolled in the study group. Age-matched OAB patients without CNS lesions were selected to serve as a control group. OnabotulinumtoxinA (100 U) was injected into the bladder suburothelium at 20 sites. The clinical effects, adverse events, and urodynamic parameters were assessed at baseline and 3 months post-treatment. The Kaplan-Meier method was used to compare long-term success rates between groups.ResultsA total of 40 patients with OAB due to CVA (23), PD (9), dementia (8) and 160 control patients were included in this retrospetive analysis. Improvement of urgency severity scale, increased bladder capacity and increased post-void residual volume were comparable between the groups at 3 months. Patients with CNS lesions did not experience increased risks of acute urinary retention and urinary tract infection; nonetheless, patients with CVA experienced a higher rate of straining to void. Long-term success rates did not differ between the patients with and without CNS lesions.ConclusionIntravesical injection of 100 U of onabotulinumtoxinA effectively decreased urgency symptoms in elderly OAB patients with CNS lesions. The adverse events were acceptable, and long-term effects were comparable to OAB patients in general. Nonetheless, the possibility of longstanding urinary retention and chronic catheterization need careful evaluation for this very vulnerable population before choosing intravesical onabotulinumtoxinA treatment.

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Incomplete Bladder Emptying in Patients With Stroke: Is Detrusor External Sphincter Dyssynergia a Potential Cause?

Cited by 28 publications

References 20 publications

Análise da relação entre sintomas urinários e topografia da lesão cerebral em pacientes com acidente vascular cerebral

Análise da relação entre sintomas urinários e topografia da lesão cerebral em pacientes com acidente vascular cerebral

Video-urodynamic characteristics of non-neurogenic, idiopathic underactive bladder in men – A comparison of men with normal tracing and bladder outlet obstruction

Efficacy and Safety of Intravesical OnabotulinumtoxinA Injection on Elderly Patients with Chronic Central Nervous System Lesions and Overactive Bladder

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