Análise da relação entre sintomas urinários e topografia da lesão cerebral em pacientes com acidente vascular cerebral

Abstract

Objective: This study analyzed the relation between brain injury topography and bladder dysfunction in patients with ischemic and hemorrhagic stroke by comparing the brain region affected with lower urinary tract symptoms (LUTS). Material and Methods: A retrospective study developed by the SARAH Network of Rehabilitation Hospitals in Brazil, involving 132 patients with chronic stroke attended by an adult neurological rehabilitation program, from January 2008 to December 2011. Results: 106 patients (80.3%) showed ischemic stroke sequelae and 26 (19.7%) hemorrhagic stroke sequelae. Patient mean age was 56.0±13.1 years and the mean period since stroke occurrence was 21.4 months. Regarding voiding behavior, 35.6% (n=47) showed bladder continence, 45.5% (n=60) presented LUTS, and 18.9% (n=25) presented continuous urinary incontinence. The presence of continuous urinary incontinence was significantly associated with extensive lesions in the frontal-parietal-temporal-occipital regions (p=0.001), cognitive deficits (p=0.001) and aphasia (p=0.001). In patients with frontoparietal lesions, associations were observed for urgency (p=0.05), urge urinary incontinence (p=0.042), urinary incontinence (p=0.019) and pollakisuria (p=0.042). Conclusion: Data showed that cognitive impairment and aphasia were correlated with continuous urinary incontinence. Regarding brain injury topography, associations were determined between lesions to the frontal-parietal region and symptoms of urgency, urge urinary incontinence, stress urinary incontinence and pollakisuria, while extensive brain injury was associated with continuous urinary incontinence.