Stroke patients who regain urinary continence in the first week after acute first‐ever stroke have better prognosis than patients with persistent lower urinary tract dysfunction

Rotar, Melita; Blagus, Rok; Jeromel, Miran; Škrbec, Miha; Tršinar, Bojan; Vodušek, David B.

doi:10.1002/nau.21013

Cited by 42 publications

(27 citation statements)

References 25 publications

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“…Wehrberger et al reported a higher risk of cardiovascular disease and stroke events (adjusted hazard ratio 3.82, p = 0.01) for men with severe LUTS during a mean follow-up period of 6.1 years, after adjusting for age, diabetes, total- and low-density lipoprotein cholesterol in a 10-year follow-up longitudinal analysis, although moderate LUTS do not seem to be a risk factor for cardiovascular disease and stroke (adjusted hazard ratio 0.63, p = 0.16) [10]. It has also been shown that urinary incontinence is a predictor of an increased risk of mortality and poor functional recovery as well as of post-stroke institutionalization [32]. LUTS was considered a prognostic factor after acute first-ever stroke.…”

Section: Discussionmentioning

confidence: 99%

“…LUTS was considered a prognostic factor after acute first-ever stroke. Patients who regain normal bladder control in the first week have a prognosis that is comparable to that of patients who do not have micturition disturbances following a stroke [32]. Therefore, the increased economic burden raises the possibility that treating LUTS/OAB at an early stage can both improve patient care and minimize overall use of health-care resources [30].…”

Section: Discussionmentioning

confidence: 99%

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Medical Attendance for Lower Urinary Tract Symptoms Is Associated with Subsequent Increased Risk of Outpatient Visits and Hospitalizations Based on a Nationwide Population-Based Database

Weng

Hsu

et al. 2013

PLoS ONE

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IntroductionLower urinary tract symptoms (LUTS), which encompass storage, voiding, and postmicturition symptoms, are highly prevalent and recognized globally. Based on a nationwide population-based database, this study tests the hypothesis that medical attendance for LUTS is associated with a subsequent increase in the number of outpatient visits and hospitalizations, with differences among medical specialties and age groups.MethodsParticipants were selected from a random population sample of approximately one million people as a representative cohort of National Health Insurance (NHI) enrollees in Taiwan. Participants had at least three outpatient service claims with a coding of LUTS during the recruitment period 2001–2004. Both the LUTS group and non-LUTS control group were monitored for subsequent outpatient visits and hospitalizations, excluding LUTS-related healthcare services, for 2 years following the index date. The results were categorized based on medical specialty and age group.ResultsThe outpatient visit rates (no. per person-year) and adjusted incidence rate ratios (IRRs) (95% confidence interval (CI) were significantly higher in urology (4.51, 95%CI 4.15–4.91) and gynecology (1.82, 95%CI 1.76–1.89) for the LUTS group. They were also significantly high in other departments, including internal medicine (1.25), general practice (1.13), Chinese medicine (1.77), family medicine (1.19), surgery (1.38), and psychiatry (1.98). Similarly, the hospitalization rate (no. per 1000 person-year) and adjusted IRRs (95% CI) were significantly higher in urology (5.50, 95% CI = 4.60–6.50) and gynecology (1.60, 95% CI = 1.35–1.90), as well as in internal medicine (1.55) and surgery (1.56), but not in psychiatry (1.12). Furthermore, the IRRs differed among 3 age groups.ConclusionsA significantly higher number of outpatient visits and hospitalizations were observed for individuals with LUTS, compared to the control group, and the effects differed with the advancement of age. This study broadens understanding of LUTS by viewing their impact on healthcare services with multiple and overlapping systems, rather than considering them exclusively as symptoms of traditional diseases of the bladder and urethra.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Medical Attendance for Lower Urinary Tract Symptoms Is Associated with Subsequent Increased Risk of Outpatient Visits and Hospitalizations Based on a Nationwide Population-Based Database

Weng

Hsu

et al. 2013

PLoS ONE

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“…Die Harninkontinenz ist ein prognostischer Faktor für den Schweregrad des Schlaganfalls und die anschließende Genesung, da mit persistierender Harninkontinenz nach Schlaganfall die Wahrscheinlichkeit von Invalidität und Tod zunimmt [10,54].…”

Section: Funktionsstörungen Des Uht Bei Msaunclassified

Neurourologische Funktionsstörungen des unteren Harntraktes bei Erkrankungen des ZNS

Mehnert

Nehiba

2012

Urologe

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The lower urinary tract (LUT) is regulated by a complex neural network that is subject to supraspinal control. Neurological disorders, especially of the central nervous system (CNS), can rapidly lead to disruption of this control. Multiple sclerosis, Parkinson's disease, multiple system atrophy, and stroke are neurological disorders which quite frequently cause dysfunction of the LUT. With respect to the pathophysiology of bladder dysfunction in CNS diseases there are various hypotheses regarding the individual disorders: disturbances of neural communication between the frontal cortex and pontine micturition center, between the pontine micturition center and the lumbosacral parts of the spinal cord, and between the basal ganglia, thalamus, and anterior cingulate gyrus appear to play a pivotal role in the development of bladder dysfunction. The symptoms and urodynamic presentation of LUT dysfunction can vary considerably depending on the disease and disease progression and can change in the course of the disease. The incidence and prevalence of LUT dysfunctions rise with increasing progression of the underlying neurological disease.Various conservative, minimally invasive, and open surgical procedures are available to prevent harmful sequelae and to improve the quality of life of these patients. As yet, however, few data exist on most of the treatment options in cases of the above-mentioned CNS diseases. Intermittent self-catheterization and antimuscarinic medications are among the most important conservative treatment options. Injection of botulinum neurotoxin type A into the detrusor muscle and increasingly sacral or pudendal neuromodulation are among the most important minimally invasive treatment options. Surgical methods include reconstructive continent or incontinent urinary diversion.When planning therapy the patient's current needs and neurological limitations as well as possible disease progression must be taken into consideration. It is often advisable to consult with and enlist the cooperation of the attending neurologist when planning treatment.

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“…Both have been reported to be signs of a poor prognosis in patients with stroke. [45] However, these signs were judged in the subacute or chronic phase during hospitalization, and only Nakayama et al . reported the significance of UI on arrival.…”

Section: Introductionmentioning

confidence: 99%

“…reported the significance of UI on arrival. [46–11] Moreover, even Nakayama et al . evaluated 32% of the patients with stroke in the subacute phase together with those in the acute phase.…”

Section: Introductionmentioning

confidence: 99%

Significance of urinary incontinence, age, and consciousness level on arrival among patients with stroke

Yanagawa

Yoshihara

Katô

et al. 2013

J Emerg Trauma Shock

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Purpose:We retrospectively investigated prognostic factors including urinary incontinence on arrival among the patients with stroke.Materials and Methods:A medical chart review was retrospectively performed for patients with stoke admitted between January 2010 and December 2010 in Ken-o Tokorozawa Hospital which had stroke care unit. The subjects were divided into a control group (functional outcome with modified Rankin scale (mRS) 0-3 at 3 months) and a poor group (severe disability or death, mRS 4-6).Results:There were 160 cases that had favorable outcome (the Control group) and 77 cases that had poor outcome (the Poor group). There were no significant differences between the two groups concerning the sex ratio, systolic blood pressure, heart rate, temperature, ratio of diabetes mellitus. However, the average age, ratio of hemorrhagic stroke, ratio of patients with a previous stroke, ratio of urinary incontinence upon admission, and duration of hospitalization in the Poor group was significantly higher than in the Control group. The Glasgow Coma Scale upon admission and ratio of hypertension in the Poor group were significantly lower than that in the Control group. Using a multiple logistic regression analysis, urinary incontinence (odds ratio, 3.17; 95% confidence interval, 1.45-6.93; P = 0.002), age (odds ratio, 1.04; 95% confidence interval, 1.01-1.07; P = 0.003) and Glasgow Coma Scale (odds ratio, 0.87; 95% confidence interval, 0.78-0.97; P = 0.01) were found to be factors independently associated with a poor outcome.Conclusion:Among the patients with strokes, the presence of urinary incontinence on arrival, the old age, and the level of consciousness are important prognostic factors. Physicians should therefore check for these factors when evaluating a patient who has experienced a stroke or suspected stroke.

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Stroke patients who regain urinary continence in the first week after acute first‐ever stroke have better prognosis than patients with persistent lower urinary tract dysfunction

Abstract: We confirmed that post-stroke UI is a predictor of greater mortality at 1 week, 6 months and 12 months after stroke. However, patients who regain normal bladder control in the first week have a comparable prognosis as the patients who do not have micturition disturbances following stroke.

Cited by 42 publications

References 25 publications

Medical Attendance for Lower Urinary Tract Symptoms Is Associated with Subsequent Increased Risk of Outpatient Visits and Hospitalizations Based on a Nationwide Population-Based Database

Medical Attendance for Lower Urinary Tract Symptoms Is Associated with Subsequent Increased Risk of Outpatient Visits and Hospitalizations Based on a Nationwide Population-Based Database

Neurourologische Funktionsstörungen des unteren Harntraktes bei Erkrankungen des ZNS

Significance of urinary incontinence, age, and consciousness level on arrival among patients with stroke

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