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Journal of the Korean Academy of Rehabilitation Medicine 2009;33(1):36-40.
Urodynamic Findings and Voiding Symptoms according to LesionSites in Stroke.
Park, Hyoung Wook , Shin, Yong Beom , Sohn, Hyun Joo , Chang, Jae Hyeok , Ha, Yong Hoon , Moon, Hye Jeong , Cha, Young Sun , Ko, Hyun Yoon
Department of Rehabilitation Medicine, Pusan National University School of Medicine, Korea. drkohy@gmail.com
뇌졸중 환자의 뇌병변 위치에 따른 요류동태검사 소견 및 배뇨 증상
박형욱, 신용범, 손현주, 장재혁, 하용훈, 문혜정, 차영선, 고현윤
부산대학교 의학전문대학원 재활의학교실
Abstract
Objective
To investigate urodynamic findings and voiding symptoms according to the location of brain lesion after stroke.
Method
Twenty-six patients with stroke (19 infarction, 7 hemorrhage) who had complained of voiding dysfunction were studied. Brain MRI was performed to identify the suprapontine lesion or pontine lesion. Intravesical pressure and voiding control function of the external urethral sphincters were evaluated by urodynamic study with electromyographic study of the external urethral sphincter. Also voiding symptoms were evaluated. We classified voiding dysfunction into three subgroups by urodynamic findings as follows: detrusor hyperactivity, detrusor hypoactivity, and normal. Functions of the external urethral sphincters were divided into normal, impairment of external urethral sphincter volitional control (IEUS), and detrusor-sphincter dyssynergia (DSD). The symptoms of voiding dysfunction were categorized into three types as a irritative, obstructive or mixed type.
Results
In patients with suprapontine lesion (n=22), 11 (50%) showed hyperactive detrusor and 6 (27.3%) showed hypoactive detrusor. However, in the pontine lesion (n=4), one patient (25%) was normal and the others were hypoactive detrusor. Fourteen cases (64%) of the suprapontine lesion and 1 case (25%) of pontine lesion demonstrated normal external urethral volitional control. Seven of 11 patients with irritative symptoms showed detrusor overactivity. Five of 9 patients with obstructive symptoms showed hypoactive detrusor.
Conclusion
We concluded that hyperactive detrusor in suprapontine lesion and hypoactive detrusor in pontine lesion were dominant. However, voiding symptoms in stroke patients were various according to the external urethral sphincter function as well as the detrusor activity. (J Korean Acad Rehab Med 2009; 33: 36-40)
Key Words: Stroke, Urodynamics, Neurogenic bladder


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