Voiding Difficulty Secondary to the Detrusor Hyperreflexia with Impaired Contractility (DHIC) Observed in the Patients with Supraspinal Lesions and in Aged Peoples

Bok, Taek Soon; Lee, Jeong Gu

Abstract

Urge incontinence with uninhibited detrusor contraction has been known to be a typical findings observed in the supraspinal neurologic disorders such as cerebrovascular accident(CVA). However, voiding difficulty with significant amounts of residual urine are frequently noted in the patients with organic brain diseases. Also, little is known about the exact causes of voiding difficulty in aged people without obstruction. Herein, Resnik at all have identified a specific physiological abnormality-detrusor hyperreflexia with impaired contractility (DHIC)- a distinct physiological subset of detrusor hyperreflexia. DHIC presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. We evaluated the symptoms and urodynamic findings for the 50 patients with supraspinal neuropathies and, also for the 28 elderly peoples complaining voiding dysfunction without evidence of bladder outlet obstruction or, pathologies in the brain. Of the 50 patients with parenchymal brain disease, 41 had CVA, 6 had Parkinson's disease and, 3 had senile dementia. Age of patients ranged from 52 to 89 years and 63 patients of them was man. As a results of urodynamic study; DHIC was noted in 36, DH (detrusor hyperreflexia) in 24, DH with obstructive pattern in 8, ID (impaired detrusor contractility) in 5, normal findings in 5 patients. Of the 36 patients with DHIC, CVA were noted in 19, senile dementia in 1, and, normal aged peoples in 16 cases. In 24 patients with DH, CVA were noted in 9, senile dementia in 1, Parkinson's disease in 6 and, normal aged peoples in 8 cases. Of the 8 patients showed DH with obstruction, CVA was present in 7 and, senile dementia in 1 cases. Of the 5 patients with IDC, CVA was present in 2 and, normal aged peoples in 3 cases. Patients showed DHIC, DH with obstruction and IDC complained obstructive symptoms more frequently than irritative symptoms. On the contrary, DH patients complained irritative symptoms more frequently than obstructive symptoms. Mean fraction of volume voided was 48% in DHIC and 23% in DH with obstruction, which were significantly less than 77% in DH. With this study, hyperreflexic contraction of detrusor was observed in 68(87%), and decreased contractility in 41 patients(53%). The fact that the patients showed DHIC was substantially older than those with DH may imply the decreased contractile function of the detrusor muscle by the aging process. It is also interesting that more than 90% (27/28) of the aged peoples without any pathologies exhibited abnormal findings in urodynamic study explain that the aging process itself may induce the changes of the bladder contractility. Urge incontinence due to DH has been known to be the most common findings in supraspinal lesion. However, these results showed that the impairment of detrusor contractility was also commonly found in the patients with supraspinal lesions and, in aged peoples. Treatment for the DHIC seem to be a dilemma for both the patients and physicians, and it may need emptying of residual urine in addition to the administration of anticholinergics or smooth muscle relaxants.