A STUDY OF MICTURITIONAL FUNCTION AT ATTACK, ACUTE AND RECOVERY PHASES OF CEREBROVASCULAR ATTACKS

Abstract

Sixty-six patients with either cerebral infarction (48 cases) or cerebral bleeding (18 cases) including
30 men and 36 women were selected for the present study to investigate micturitional conditions immediately after the attack (attack phase) and urodynamic status within 2 weeks after the episode (acute phase). None of them had obstructive disorders of the urinary tract before the attack. Further studied were changes of the above micturitional functions with elapsed time up to reestablishment of self controlled micturition (recovery phase) and factors possibly influencing the recovery of micturitional functions such as property and localization of brain lesion, disturbed consciousness and moving disability.
Brain lesions were identified and localised with computed tomography, and divided into two groups of small and large lesions; those less and larger than one third of cerebral hemisphere, respectively. The presence or absence of the lesion invading cerebral basal ganglia and posterior internal capsula was also confirmed. Mitutional condition was difined as normal micturition, urgency incontinence (incontinence with residual urine less than 100 ml), urinary retention (incapability of voiding in the presence of bladder urine over 400 ml) and overflow incontinence (incontinence with residual urine more than 100 ml). At acute phase, normal micturition, urgency incontinence, urinary retention and overflow incontinence were observed in 2, 13, 17 and 34 patients, respectively. Overflow incontinence was observed in 19 (70%) of 27 patients with large cerebral lesions and in 18 of 24 patients with mildly or severely disturbed consciousness. Many of 13 patients revealing urgency incontinence had cerebral lesions invading basal ganglion (12/13), had hyperactive bladder (9/10) and decreased external urethral function (5/10). Many of patients who revealed urinary retention had cerebral lesions invading neither basal ganglion nor posterior internal capsula (10/17), and showed inactive bladder (8/10) and decreased external urethral function (6/10). Of the patients who revealed overflow incontinence, half had lesions invading both basal ganglion and posterior internal capsula, but vesico-urethral function of them was varied by the patient, suggesting that overflow incontinence at attack phase is a micturitional condition attributable to both disturbed consciousness and organic disorders. At the acute phase, normal, hyperactive and inactive bladder were respectively observed in 27, 33 and 40% of 41 patients examined. At recovery phase, normal bladder was found to increase to 33%. Sphincteric function of external urethra was found almost unchanged from acute phase to the recovery phase. Decreased, normal and enhanced responses were respectively observed in 18, 11 and 1 patients for external anal sphincter and in 15, 13 and 2 patients for bulbocavernosus reflex. None showing enhanced response achieved self controlled voiding. Eight of 9 patients who could not achieve self controlled micturition had cerebral infarction, of which six had large cerebral lesion. Clinically, overflow incontinence, enhanced external sphincteric function suggested disadvantage for achieving self controlled voiding. The period required to achieve self controlled voiding from attack was significantly longer in the patients with overflow incontinence (53.7±9.7 days) than those with either urgency incontinence (28.7±6.9 days) or urinary retention (34.3±9.1 days). Ability of exercise was also found to be an important factor to achieve self controlled voiding.