Lower Urinary Tract Dysfunction in Stroke Patients

腦中風患者之下尿路功能障礙

陳奕舟(Yih-Chou Chen) ； 廖永明(Yung-Ming Liao) ； 郭漢崇(Hann-Chorng Kuo)

《臺灣泌尿科醫學會雜誌》 18卷3期 (2007/09) Pp. 147-150

摘要

目的：評估不同種類之中風及其下尿路功能障礙之間的關係。
材料及方法：170名腦中風患者因其下尿路功能障礙被納入研究，病患依不同種類、不同部位及中風時間長短之不同加以分類，並加以分析其下尿路症狀及尿路動力學檢查結果，統計是否與下尿路功能障礙有顯著相關性。
結果：本研究對象共170名1997年至2006年間之腦中風患者，平均年齡70.21歲，平均追蹤期間為32.7個月，分析結果顯示較多的缺血性腦中風患者(48.4%)及中風超過一年者(53.9%)以急尿感為主要表現，中風一年內之患者以尿滯留為多(45.7%)，而大腦天幕上中風患者與大腦天幕下中風患者兩組無顯著差異，三組尿路動力學上表現均以逼尿肌活性過強及協調性良好之尿道括約肌為主要表現。
結論：逼尿肌活性過強及協調性良好之尿道括約肌為腦中風患者最常見之尿路動力學檢查結果，中風一年內者多以尿滯留為表現而超過一年者則以急尿感為表現，錄影尿路動力學檢查對於腦中風患者可排除是否排尿障礙是因攝護腺增生所造成。

關鍵字

腦中風 ； 出血性 ； 缺血性 ； 下尿路功能障礙

並列摘要

OBJECTIVE: This study investigated the association between different types of stroke and the associated lower urinary tract dysfunction (LUTD).
MATERIALS AND METHODS: In total, data on 170 stroke patients with LUTD from 1997 to 2006 were collected. Patients with preexisting urologic disease were excluded. Lower urinary tract symptoms (LUTSs) of these patients were recorded and a videourodynamic study (VUDS) was performed on every patient. The patients were categorized into hemorrhagic and ischemic stroke groups according to the disease and were grouped into supratentorium and infratentorium groups according to the location of the lesion. The LUTS and VUDS findings were compared between different stroke groups. In addition, patients whose stroke had occurred more than 12 months previous were also compared to those whose stroke had occurred within the past 12 months.
RESULTS: The main LUTSs in the ischemic stroke group were urgency (48%) and incontinence (47.1%), followed by urinary retention (33.3%). In the hemorrhagic stroke group, urinary retention was noted in 45.6%, urinary incontinence in 16.8%, and urgency in 29.4% of patients. Urgency was more commonly found in the ischemic than in the hemorrhagic stroke group (p＜0.05). Detrusor overactivity was found in 71.6% and 69.1% while a coordinated urethral sphincter was found in 71.6% and 61.8% of patients with ischemic and hemorrhagic stroke, respectively. The LUTS and urodynamic findings were similar between patients with a supratentorial stroke and those with an infratentorial stroke. The most common presenting LUTSs in patients whose stroke had occurred ＞12 and ≤12 months previous were urgency (53.9%) and urine retention (45.7%), respectively. Significantly more patients whose stroke had occurred ≤12 months previous (77.7%) had urodynamic detrusor overactivity than those whose stroke had occurred ＞12 months previous (61.8%). CONCLUSIONS: Detrusor overactivity was commonly found in both ischemic and hemorrhagic stroke patients, and most of the patients had a coordinated urethral sphincter. No obvious differences in LUTSs and urodynamic findings were found between patients with different lesion locations.

並列關鍵字

stroke ； hemorrhage ； ischemia ； lower urinary tract dysfunction