Urodynamic Evaluation of Patients with Intracranial Lesions according to Lesion Site

Kim, Hyung Jee; Lee, Suk Jae; Lee, Gil Ho

Abstract

PURPOSE
Typical urodynamic findings in patients with intracranial lesion is detrusor hyperreflexia with coordinated sphincter activity. However the findings of urodynamic study may be different from this typical findings, because neurological net effect on voiding function should be variable according to the degree and site of intracranial lesions, the presence of underlying disease and adequacy of initial management of voiding problems from onset of accident. This study was performed to evaluate the type of voiding dysfunction on the anatomic lesion of brain mainly. MATERIAL AND METHODS: In this study, we have retrospectively tried to evaluate the urodynamic findings in 108 patients who had intracranial lesion. Computerized tomography or magnetic resonance imaging was performed to localize the intracranial lesions.
RESULTS
Mean patient age was 59.4 years(range 10 to 87). In 108 cases, cerebral infarct was in 47 cases, 29 cases of intracranial hemorrhage, 8 cases of Parkinsonism and 24 cases of other diseases. Patient were grouped according to the presenting voiding complaints, such as 46 cases of irritative symptom and 62 cases of obstructive symptom. Underlying diseases such as diabetic mellitus were 21 cases, which showed hyperreflexia or areflexia. In urodynamic study, detrusor hyperreflexia was noted in 64% of patients, detrusor hyperreflexia with impaired contractility in 14.8% and detrusor areflexia in 18.5%. Patients with detrusor sphincter dyssynergia(DSD) were 14 cases, but only 2 cases had true DSD. In 108 cases according to brain lesion, lesion sites were on basal ganglia in 23 cases and on basal ganglia and thalamus in the 22 cases. Urodynamic study revealed 14 cases of detrusor hyperreflexia in patients with basal ganglia lesion and 14 cases of detrusor hyperreflexia in patients with basal ganglia and thalamus lesion. The involvement of frontal lobe or diffuse lesion showed detrusor areflexia and others showed detrusor hyperreflexia mainly. Most of treatment method was medical therapy(63.9%).
CONCLUSION
Presenting symptoms did not predict the urodynamic findings and treatment. Underlying diseases may exacerbate the symptom of the intracranial lesion induced voiding dysfunction. Our study indicates the need to consider bladder outlet obstruction as a cause of urinary retention in old men who suffered from a stroke. On the basis of this study, it is assumed that the effect of the basal ganglia on micturition is inhibitory in nature. Evaluation of underlying diseases and intracranial lesion seems to be helpful in making the protocol of treatment of voiding dysfunction with intracranial lesion.