CYSTOMETRY AND URETHRAL PRESSURE PROFILOMETRY AFTER THE CEREBRAL STROKE

Abstract

1) 49 patients (26 male cases and 23 female cases) who sustained cerebral stroke (Apoplexy) of various etiologies were urodynamically examined by cystometry and urethral pressure profilometry (UPP).
2) The subjects were further divided into 31 acute cases (defined as those who were within 48 hours after the stroke), 3 interim cases, and 15 chronic cases (2 weeks to 12 years post stroke).
In the 31 acute cases cystometry was “normal” type in 9, “uninhibited” type in 15 and “atonic” type in 7.
In 3 interim cases it was “normal” in 1 and “uninhibited” type in 2.
In the 15 chronic cases it was “normal” in 3, “uninhibited” in 9, “automatic” in 1 and “autonomoautomatic” in 2.
3) Serial urodynamic examinations were performed in 17 of these cases.
a) “normal” type tended either to remain “normal” or to change into “uninhibited” type.
b) “atonic” type from the onset of illness was subsequently normalized in all.
c) “uninhibited” type had remained so, although Buscopan (Hyoscine N-Butyl bromide) was found to be effective in increasing the bladder capacity in 2 to 3 months after the stroke.
d) Both “automatic” and “autonomoautomatic” type either changed into “uninhibited” or remained “autonomoautomatic” in the subsequent examination. These suggest that “uninhibited” type is more prevalently seen in the later phase of cerebral stroke.
4) UPP was obtained in 22 acute cases (12 males and 10 females) and 6 chronic female cases.
The posterior urethral length in the acute cases was 4.0±0.9cm and 2.9±0.3cm in males and females respectively.
A slight increase in the urethral length when compared to the normal control (3.6±0.9cm in the male and 2.8±0.4cm in the female) is statistically insignificant. It was similar (2.5±0.4cm) in the chronic female.
Maximal urethral pressure (UP max) in the males was 23.9±10.3mmHg, while it was 30.0±6.6mmHg in the normal males, but the difference was statistically insignificant.
In the female it was 16.5±9.3mmHg in the acute phase, which is statistically significant compared to 23.5±5.9mmHg of UP max of normal females, while in the chronic phase it was 19.3±4.1mmHg, the difference from the normal was considered to be statistically insignificant.
Urinary retension was of a transient nature and seen only during the acute phase of the stroke, and urinary incontinence appeared to be related to uninhibited detrusor contraction rather than to parameters of UPP.
5) There was no correlation between urodynamic findings and multitude of somatic reflexes such as abdominal, cremasteric, patellar tendon, plantar, anal and bulbocavernous reflex, and other pathologic reflexes.
6) Based on these urodynamic investigations the management of the bladder in stroke patients was described.
Even in the acute phase unassisted self voiding is recommended regardless to the urodynamic result providing the patients were alert and residual urine was less than 30cc.
In the others when cystometry demonstrated either “normal” or “atonic” type the bladder was drained intermittently by periodic unclamping of indwelled urethral catheter, while the bladder training was continued. When residual urine was noted to be less than 30cc which was usually attained within a month, they were freed from the use of urethral catheter.
When bladder was “uninhibited” type it was similarly managed with indwelling urethral catheter, but Buscopan was used to prevent urinary leak around the catheter. This along with bladder training usually restored an adequate bladder capacity and rendered the patients catheter free usually within 3 to 9 months after the episode of stroke.