Epidemiology and prognostic significance of bladder sphincter disorders after an initial cerebral hemisphere vascular accident

OBJECTIVE: To document incidence of poststroke urinary incontinence and retention and to determine its effect on 3 months outcome. METHODS: Prospective cohort study. One hundred fifty-five cases of first hemispherical stroke were classified by continence status, retention or incontinence, at D2 after stroke. Age, sex, stroke location and aetiology, hypertension, diabetes were noted. Outcome data collected at D15 and D90 included impairments, disabilities, quality of life and case fatality rates. Disabilities were measured with Barthel Index (BI), Franchay Arm Test (FAT), New Functional Ambulation Classification (NFAC) and quality of life with EuroQol. RESULTS: Of the 155 patients, 62 had initial urinary disorders. The incidence was 40% at D2, 32% at D15 and 19% at D90. Retention represented 36% of urinary disorders at D2 and D15 and only 19% at D90. Urinary disorders were associated with motor weakness, lower Barthel Index, dysphasia, aphasia, apraxia and unilateral neglect. There was no relation with sex, age, stroke aetiology and diabetes. At D90, patients with initial urinary disorders had higher case fatality rates 22% versus 16% (P < 0.0001) and greater disabilities: BI of 60 versus 90 (P < 0.0001), NFAC of five versus seven (P < 0.0001), FAT of four versus six (P = 0.0019). CONCLUSION: Poststroke urinary disorders were associated with stroke gravity and adversely affected D90 stroke survival rates and functional outcome. Retention was strongly associated with D90 survival rates.