POL Scientific / Bladder / Volume 11 / Issue 1 / DOI: 10.14440/bladder.2024.0012
Submit to Bladder
Cite this article
14
Download
42
Citations
206
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
REVIEW

Bladder dysfunction following stroke: An updated review on diagnosis and management

Eleni Agapiou1,2 ,  Efstratios-Stylianos Pyrgelis1,3* ,  Ioannis N. Mavridis1,4 ,  Maria Meliou1 ,  Welege Samantha Buddhika Wimalachandra1
Show Less
1 C.N.S. Alliance Research Group, Athens, Greece
2 Department of Physical Medicine and Rehabilitation, “Asklipieion Voulas” General Hospital, Voula, Athens, Greece
3 First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
4 Department of Neurosurgery, School of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupoli, Greece
Bladder 2024 , 11(1), e21200005; https://doi.org/10.14440/bladder.2024.0012
Submitted: 1 July 2024 | Revised: 28 July 2024 | Accepted: 7 August 2024 | Published: 23 August 2024
© 2024 by the Bladder published by POL Scientific. Licensee POL Scientific, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
Cite
XML
HTML
Abstract

Bladder dysfunction represents a frequent and important clinical problem in stroke patients. The aim of this narrative review was to explore the currently available information regarding the diagnosis and management of bladder dysfunction following stroke. The most common symptoms of bladder dysfunction following stroke are urinary incontinence, urgency, increased frequency, and difficulty voiding. Medical history, including voiding diary, physical examination, and urodynamic studies are useful in establishing diagnosis. Bladder pressure in stroke patients with detrusor overactivity is rarely high enough to damage the upper urinary tract. In neurogenic bladder, however, there is always a risk for transmission of intravesical pressure to the upper tract. In incontinent patients, urodynamic studies can reveal bladder hyper- or hyporeflexia, detrusor overactivity with impaired contractility or detrusor-sphincter dyssynergia, or even no abnormalities at all. With stroke patients with urinary dysfunction, establishing a proper diagnosis is of paramount importance to start appropriate treatment, prevent upper tract damage, maintain continence, and ensure complete emptying. After diagnosis, an individually tailored treatment plan is mandatory, including behavioral techniques, lifestyle interventions, and anticholinergic medication. Other therapeutic choices include alternative drugs, intradetrusor injection of botulinum toxin, and spinal neuromodulation. A bladder rehabilitation program is essential for improving post-stroke lower urinary symptoms and depends on the patient’s awareness, cooperation, and independence. Bladder dysfunction after stroke, as a strong prognostic factor of disability, exerts an enormous impact on health and economy. Therefore, every single effort toward a proper diagnosis and effective rehabilitation is crucial.

Keywords
Bladder dysfunction
Lower urinary tract dysfunction
Stroke
Urinary incontinence
Urodynamic studies
Funding
None.
References
  1. Kim BR, Lee J, Sohn MK, et al. Risk factors and functional impact of medical complications in stroke. Ann Rehabil Med. 2017;41(5):753-760. doi: 10.5535/arm.2017.41.5.753

 

  1. Liang CC, Shaw SW, Huang YH, Lin YH, Lee TH. Bladder transplantation of amniotic fluid stem cell may ameliorate bladder dysfunction after focal cerebral ischemia in rat. Stem Cells Transl Med. 2017;6(4):1227-1236. doi: 10.1002/sctm.16-0212

 

  1. Tekeoğlu Y, Adak B, Göksoy T. Effect of transcutaneous electrical nerve stimulation (TENS) on barthel activities of daily living (ADL) index score following stroke. Clin Rehabil. 1998;12(4):277-280. doi: 10.1191/026921598672873816

 

  1. Kuptniratsaikul V, Kovindha A, Suethanapornkul S, Manimmanakorn N, Archongka Y. Complications during the rehabilitation period in Thai patients with stroke: A multicenter prospective study. Am J Phys Med Rehabil. 2009;88(2):92-99. doi: 10.1097/PHM.0b013e3181909d5f

 

  1. Lorish TR, Sandin KJ, Roth EJ, Noll SF. Stroke rehabilitation. 3. Rehabilitation evaluation and management. Arch Phys Med Rehabil. 1994;75(5 Spec No):S47-S51.

 

  1. Olai L, Borgquist L, Svärdsudd K. Health problems in elderly patients during the first post-stroke year. Ups J Med Sci. 2012;117(3):318-327. doi: 10.3109/03009734.2012.674572

 

  1. Yoo KH, Lee SJ, Chang SG. Predictive value of the ischemic stroke lesion to detrusor function. Neurourol Urodyn. 2010;29(7):1355-1356. doi: 10.1002/nau.20885

 

  1. Salehi-Pourmehr H, Hajebrahimi S, Rahbarghazi R, et al. Stem cell therapy for neurogenic bladder dysfunction in rodent models: A systematic review. Int Neurourol J. 2020;24(3):241-257. doi: 10.5213/inj.20040058.029

 

  1. Akkoç Y, Bardak AN, Ersöz M, et al. Post-stroke lower urinary system dysfunction and its relation with functional and mental status: A multicenter cross-sectional study. Top Stroke Rehabil. 2019;26(2):136-141. doi: 10.1080/10749357.2018.1555389

 

  1. Gelber DA, Good DC, Laven LJ, Verhulst SJ. Causes of urinary incontinence after acute hemispheric stroke. Stroke. 1993;24(3):378-382. doi: 10.1161/01.str.24.3.378

 

  1. Mehdi Z, Birns J, Bhalla A. Post-stroke urinary incontinence. Int J Clin Pract. 2013;67(11):1128-1137. doi: 10.1111/ijcp.12183

 

  1. Guo GY, Kang YG. Effectiveness of neuromuscular electrical stimulation therapy in patients with urinary incontinence after stroke: A randomized sham controlled trial. Medicine (Baltimore). 2018;97(52):e13702. doi: 10.1097/MD.0000000000013702

 

  1. Panfili Z, Metcalf M, Griebling TL. Contemporary evaluation and treatment of poststroke lower urinary tract dysfunction. Urol Clin North Am. 2017;44(3):403-414. doi: 10.1016/j.ucl.2017.04.007

 

  1. Sakakibara R. Lower urinary tract dysfunction in patients with brain lesions. Handb Clin Neurol. 2015;130:269-287. doi: 10.1016/B978-0-444-63247-0.00015-8

 

  1. Kohler M, Mayer H, Battocletti M, Kesselring J, Saxer S. Wirksamkeit von nichtmedikamentösen interventionen zur förderung der urinkontinenz bei menschen nach einem cerebro-vaskulären insult - eine systematische literaturübersicht [Effectiveness of non-pharmacological interventions to promote urinary continence in stroke survivors - a systematic literature review]. Pflege. 2016;29(5):235-245. [German]. doi: 10.1024/1012-5302/a000493

 

  1. McKenzie P, Badlani GH. The incidence and etiology of overactive bladder in patients after cerebrovascular accident. Curr Urol Rep. 2012;13(5):402-406. doi: 10.1007/s11934-012-0269-6

 

  1. Miyazato M, Kadekawa K, Kitta T, et al. New frontiers of basic science research in neurogenic lower urinary tract dysfunction. Urol Clin North Am. 2017;44(3):491-505. doi: 10.1016/j.ucl.2017.04.014

 

  1. European Association of Urology. EAU Guidelines Edition. Presented at the EAU. Annual Congress Paris; 2024.

 

  1. Satkunam LE. Rehabilitation medicine: 3. Management of adult spasticity. CMAJ. 2003;169(11):1173-1179.

 

  1. Amarenco G. Troubles vésico-sphinctériens d’origine nerveuse [Vesico-sphincter disorders of nervous origin]. Rev Prat. 1995;45(3):331-335. [French].

 

  1. Chartier-Kastler E, Mozer P, Ayoub N, Richard F, Ruffion A. Hypertrophie bénigne de la prostate et neuro-urologie [Benign prostatic hyperplasia and neurourology]. Prog Urol. 2007;17(3):529-534. [French]. doi: 10.1016/s1166-7087(07)92363-5

 

  1. Kasyan GR, Dreval RO, Krivoborodov GG, et al. [Socio-economic aspects of neurogenic dysfunctions in urology]. Urologiia. 2020;5:127-132. [Russian].

 

  1. Pehrson R, Stenman E, Andersson KE. Effects of tramadol on rat detrusor overactivity induced by experimental cerebral infarction. Eur Urol. 2003;44(4):495-499. doi: 10.1016/s0302-2838(03)00353-1

 

  1. Middaugh SJ, Whitehead WE, Burgio KL, Engel BT. Biofeedback in treatment of urinary incontinence in stroke patients. Biofeedback Self Regul. 1989;14(1):3-19. doi: 10.1007/BF00999338

 

  1. Akkoç Y, Yıldız N, Bardak AN, et al. The course of post-stroke bladder problems and their relation with functional and mental status and quality of life: A six-month, prospective, multicenter study. Turk J Phys Med Rehabil. 2019;65(4):335-342. doi: 10.5606/tftrd.2019.3205

 

  1. Smith CE, Schneider MA. Assessing postvoid residual to identify risk for urinary complications post stroke. J Neurosci Nurs. 2020;52(5):219-223. doi: 10.1097/JNN.0000000000000536

 

  1. Ouyang M, Billot L, Song L, et al. Prognostic significance of early urinary catheterization after acute stroke: Secondary analyses of the international HeadPoST trial. Int J Stroke. 2021;16(2):200-206. doi: 10.1177/1747493020908140

 

  1. Liu HT, Liu AB, Chancellor MB, Kuo HC. Urinary nerve growth factor level is correlated with the severity of neurological impairment in patients with cerebrovascular accident. BJU Int. 2009;104(8):1158-1162. doi: 10.1111/j.1464-410X.2009.08533.x

 

  1. Lee HS, Choi JG, Shin JH. Urological disturbance and its neuroanatomical correlate in patients with chronic brainstem stroke. Neurourol Urodyn. 2017;36(1):136-141. doi: 10.1002/nau.22889

 

  1. Shukla R, Giri P, Bhandari A, Shankhwar SN. Pontine stroke and bladder dysfunction. BMJ Case Rep. 2014;2014:bcr2013200787. doi: 10.1136/bcr-2013-200787

 

  1. Yum KS, Na SJ, Lee KY, et al. Pattern of voiding dysfunction after acute brainstem infarction. Eur Neurol. 2013;70(5-6):291-296. doi: 10.1159/000352040

 

  1. Tateno F, Sakakibara R, Aiba Y, et al. Bladder autonomic dysfunction after a parietal stroke. J Stroke Cerebrovasc Dis. 2020;29(4):104620. doi: 10.1016/j.jstrokecerebrovasdis.2019.104620

 

  1. Wu MN, Guo YC, Lai CL, Shen JT, Liou LM. Poststroke detrusor hyporeflexia in a patient with left medial Pontine infarction. Neurologist. 2012;18(2):73-75. doi: 10.1097/NRL.0b013e318247b9d9

 

  1. Saint S, Trautner BW, Fowler KE, et al. A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA Intern Med. 2018;178(8):1078-1085. doi: 10.1001/jamainternmed.2018.2417

 

  1. Pettersen R, Stien R, Wyller TB. Post-stroke urinary incontinence with impaired awareness of the need to void: Clinical and urodynamic features. BJU Int. 2007;99(5):1073-1077. doi: 10.1111/j.1464-410X.2007.06754.x

 

  1. Jeanson G, Lebreton F. Corrélats neuroanatomiques entre lésions AVC et troubles urinaires: Une revue de la littérature [Neuroanatomical correlates between stroke lesions and urinary disorders: A narrative review]. Prog Urol. 2019;29(4):226-234. [French]. doi: 10.1016/j.purol.2018.10.004

 

  1. Burney TL, Senapati M, Desai S, Choudhary ST, Badlani GH. Acute cerebrovascular accident and lower urinary tract dysfunction: A prospective correlation of the site of brain injury with urodynamic findings. J Urol. 1996;156(5):1748-1750. doi: 10.1016/s0022-5347(01)65498-3

 

  1. Kreydin EI, Gad P, Gao B, Liu CY, Ginsberg DA, Jann K. The effect of stroke on micturition associated brain activity: A pilot fMRI study. Neurourol Urodyn. 2020;39(8):2198-2205. doi: 10.1002/nau.24473

 

  1. Sakakibara R. Editorial comment to effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms. Int J Urol. 2010;17(7):660. doi: 10.1111/j.1442-2042.2010.02549.x

 

  1. Pelz JO, Fischer MM, Bungert-Kahl P, Lindner D, Fricke C, Michalski D. Fluid balance variations during the early phase of large hemispheric stroke are associated with patients’ functional outcome. Front Neurol. 2019;10:720. doi: 10.3389/fneur.2019.00720

 

  1. Ersoz M, Ulusoy H, Oktar MA, Akyuz M. Urinary tract infection and bacteriurua in stroke patients: Frequencies, pathogen microorganisms, and risk factors. Am J Phys Med Rehabil. 2007;86(9):734-741. doi: 10.1097/PHM.0b013e31813e5f96. Erratum in: Am J Phys Med Rehabil. 2007;86(12):1038.

 

  1. Kovindha A, Wattanapan P, Dejpratham P, Permsirivanich W, Kuptniratsaikul V. Prevalence of incontinence in patients after stroke during rehabilitation: A multi-centre study. J Rehabil Med. 2009;41(6):489-491. doi: 10.2340/16501977-0354

 

  1. Liao L. Evaluation and management of neurogenic bladder: What is new in China? Int J Mol Sci. 2015;16(8):18580-18600. doi: 10.3390/ijms160818580

 

  1. Pizzi A, Falsini C, Martini M, Rossetti MA, Verdesca S, Tosto A. Urinary incontinence after ischemic stroke: Clinical and urodynamic studies. Neurourol Urodyn. 2014;33(4):420-425. doi: 10.1002/nau.22420

 

  1. Kodama K, Yokoyama O, Komatsu K, Yotsuyanagi S, Niikura S, Namiki M. Contribution of cerebral nitric oxide to bladder overactivity after cerebral infarction in rats. J Urol. 2002;167(1):391-396.

 

  1. Yared JE, Gormley EA. The role of urodynamics in elderly patients. Clin Geriatr Med. 2015;31(4):567-579. doi: 10.1016/j.cger.2015.06.003

 

  1. Nitti VW, Adler H, Combs AJ. The role of urodynamics in the evaluation of voiding dysfunction in men after cerebrovascular accident. J Urol. 1996;155(1):263-266.

 

  1. Wald ME. Cerebral thrombosis: Assessment and nursing management of the acute phase. J Neurosci Nurs. 1986;18(1):36-38. doi: 10.1097/01376517-198602000-00010

 

  1. Kushner DS, Johnson-Greene D. Association of urinary incontinence with cognition, transfers and discharge destination in acute stroke inpatient rehabilitation. J Stroke Cerebrovasc Dis. 2018;27(10):2677-2682. doi: 10.1016/j.jstrokecerebrovasdis.2018.05.028

 

  1. Thomas LH, Watkins CL, Sutton CJ, et al. Identifying continence options after stroke (ICONS): A cluster randomised controlled feasibility trial. Trials. 2014;15:509. doi: 10.1186/1745-6215-15-509

 

  1. Dumoulin C, Korner-Bitensky N, Tannenbaum C. Urinary incontinence after stroke: Does rehabilitation make a difference? A systematic review of the effectiveness of behavioral therapy. Top Stroke Rehabil. 2005;12(3):66-76. doi: 10.1310/ENMX-RUV5-15WL-VNA2

 

  1. Andersson KE, Pehrson R. CNS involvement in overactive bladder: Pathophysiology and opportunities for pharmacological intervention. Drugs. 2003;63(23):2595-2611. doi: 10.2165/00003495-200363230-00003

 

  1. Nakada Y, Yokoyama O, Komatsu K, et al. Effects of aniracetam on bladder overactivity in rats with cerebral infarction. J Pharmacol Exp Ther. 2000;293(3):921-928.

 

  1. Shin S, Lee J, Yoo J, Lim SM, Lee E. Electroacupuncture versus sham electroacupuncture for urinary retention in poststroke patients: Study protocol for a multicenter, randomized controlled trial. Trials. 2016;17:197. doi: 10.1186/s13063-016-1315-3

 

  1. Kreydin E, Zhong H, Latack K, Ye S, Edgerton VR, Gad P. Transcutaneous electrical spinal cord neuromodulator (TESCoN) improves symptoms of overactive bladder. Front Syst Neurosci. 2020;14:1. doi: 10.3389/fnsys.2020.00001

 

  1. Havton LA, Christe KL, Edgerton VR, Gad PN. Noninvasive spinal neuromodulation to map and augment lower urinary tract function in rhesus macaques. Exp Neurol. 2019;322:113033. doi: 10.1016/j.expneurol.2019.113033

 

  1. Peters KM, Kandagatla P, Killinger KA, Wolfert C, Boura JA. Clinical outcomes of sacral neuromodulation in patients with neurologic conditions. Urology. 2013;81(4):738-743. doi: 10.1016/j.urology.2012.11.073

 

  1. Monteiro ÉS, de Carvalho LB, Fukujima MM, Lora MI, do Prado GF. Electrical stimulation of the posterior tibialis nerve improves symptoms of poststroke neurogenic overactive bladder in men: A randomized controlled trial. Urology. 2014;84(3):509-514. doi: 10.1016/j.urology.2014.05.031

 

  1. Sciarra A, Viscuso P, Arditi A, et al. A biofeedback-guided programme or pelvic floor muscle electric stimulation can improve early recovery of urinary continence after radical prostatectomy: A meta-analysis and systematic review. Int J Clin Pract. 2021;75(10):e14208. doi: 10.1111/ijcp.14208

 

  1. Ersoz M, Erhan B, Akkoc Y, et al. An evaluation of bladder emptying methods and the effect of demographic and clinical factors on spontaneous voiding frequency in stroke patients. Neurol Sci. 2013;34(5):729-734. doi: 10.1007/s10072-012-1123-9

 

  1. Freed MM, Wainapel SF. Predictors of stroke outcome. Am Fam Physician. 1983;28(5):119-123.

 

  1. Loewen SC, Anderson BA. Predictors of stroke outcome using objective measurement scales. Stroke. 1990;21(1):78-81. doi: 10.1161/01.str.21.1.78

 

  1. Massucci M, Perdon L, Agosti M, et al. Prognostic factors of activity limitation and discharge destination after stroke rehabilitation. Am J Phys Med Rehabil. 2006;85(12):963-970. doi: 10.1097/01.phm.0000242620.44924.1b

 

  1. Mokler PJ, Sandstrom R, Griffin M, Farris L, Jones C. Predicting discharge destination for patients with severe motor stroke: Important functional tasks. Neurorehabil Neural Repair. 2000;14(3):181-185. doi: 10.1177/154596830001400303

 

Conflict of interest
The authors declare no competing interests.
Share
Back to top
Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept