Urinary Retention Following Acute Stroke

Fifty-one consecutive patients with recent unilateral, ischemic, hemispheric stroke admitted to a neurorehabilitation unit were studied prospectively to determine the causes of post-stroke urinary retention. Elevated post-void residual urine volumes (PVR) were correlated with position of voiding (in bed or on commode), presence of incontinence, infarct location, and functional status. Urodynamic studies and cystoscopy were performed on all patients with elevated PVR. Twenty-two patients (43 percent) had elevated PVR. Urinary retention was associated with large infarcts, urinary incontinence, and functional disability (p<0.05), but not with age, sex, side of stroke, time from stroke to study entry, or position of voiding. Urodynamic studies revealed bladder outlet obstruction in 32 percent, bladder hyporeflexia in 27 percent, and combined bladder outlet obstruction and bladder hyporeflexia in 5 percent. Of eight patients in whom urodynamic studies and cystoscopy did not reveal an obvious cause for urinary retention (bladder hyperreflexia in 27 percent, normal study in 9 percent), seven were either aphasic or demented. We conclude that there are multiple causes of urinary retention following acute stroke. In cognitively impaired or aphasic patients, PVR may not provide an accurate indicator of urinary retention. Urodynamic studies are necessary to confirm the presence of urinary retention, determine the etiology, and help guide appropriate therapy.