Prognostic significance of micturition disturbances after acute stroke

OBJECTIVES: To investigate the prevalence, incidence, clinical types, and prognostic effect of micturition disturbances in acute stroke. DESIGN: Prospective observational study. SETTING: Geriatric department (stroke and rehabilitarion unit) in a community hospital (acute phase); outpatient clinic, patients' own homes, or nursing homes (3 months follow-up). PARTICIPANTS: Three hundred fifteen patients (mean age 77) with acute first-ever or recurrent stroke consecutively admitted to the hospital stroke unit. MEASUREMENTS: Premorbid basic and instrumental activities of daily living (ADLs) and mental functioning; comorbidity; previous and actual micturition symptoms; stroke syndromes; medication use; and poststroke mobility, ADLs, and cognition. RESULTS: One hundred forty-seven patients (46%) had preexisting micturition disturbances (urinary incontinence (UI), n = 98; urgency/frequency, n = 37; voiding difficulties, n = 12). Seventy-eight developed new symptoms (UI, n = 65; urgency/frequency, n = 4; sustained retention, n = 9). There were two UI types: urge UI (n = 27) and UI with impaired awareness of bladder needs (IA UI, n = 38). In regression analyses, IA UI was the only micturition disturbance predicting mortality and need for nursing home care at 3 months (odds ratio (OR) = 27.5, 95% confidence interval (CI) = 7.0-108.2), together with poor mobility (OR = 8.2, 95% CI = 2.6-26.2), and partial or total anterior circulation stroke type (OR = 3.6, 95% CI = 1.4-9.0). CONCLUSION: New-onset poststroke UI with impaired awareness of bladder needs is a strong and independent risk factor for poor outcome at 3 months. This probably reflects more serious brain damage, affecting sustained attention and information processing. Valid clinical tools to detect such dysfunction in stroke victims are needed. Clinical classification of poststroke UI is likely to improve management.