Urodynamic Evaluation in Patients with Voiding Dysfunction Associated with Intracranial Lesions

Woo, Do Shik; Lee, Gil Ho; Kim, Hyung Jee

Abstract

Typical urodynamic findings in patients with intracranial lesion are uninhibited bladder contraction (detrusor hyperreflexia) with coordinated sphincter activity. However, the findings of urodynamic study are variable and dependent on the degree and site of intracranial lesion, the presence of underlying disease and the adequacy of initial management of voiding problems from onset of the neurologic symptoms. . In this study, we tried to investigate the urodynamic findings in 40 patients who had intracranial lesions (traumatic or organic brain disease) with voiding dysfunction. The following results were obtained. 1. Out of all 40 patients, 35 had organic brain disease such as infarct, intracranial hemorrhage, or Parkinsonism etc. and 5 had traumatic brain disease. 2. Among 40 patients, detrusor hyperreflexia was presented in 29 (72.5%), detrusor areflexia in 9 (22.5%) and normal detrusor pressure in 2 (5%). 3. In 29 cases of detrusor hyperreflexia, there was no history of urinary retention, but in 12 cases with history of urinary retention, 9 cases (75%) revealed as detrusor areflexia. 4. No specific cause except the history of urinary retention was considerable in 8 of 9 patients with detrusor areflexia. In our study, urodynamic findings in the patients with intracranial lesion who had voiding dysfunction revealed nine cases (22.5%) of detrusor areflexia and the presumptive cause of detrusor areflexia is considered to previous urinary retention. Therefore, highly individualized and programmed early urologic involvement on the basis of urodynamic study is recommended for the prevention of urinary retention in initial ""cerebral shock"" stage of cerebrovascular accident and when detrusor areflexia had been developed, intensive management for the removal of the residual urine is necessary.