THE ROLE OF URODYNAMICS IN THE EVALUATION OF VOIDING DYSFUNCTION IN MEN AFTER CEREBROVASCULAR ACCIDENT

Purpose: The etiology of voiding dysfunction was determined in men aft er a cerebrovascular accident who were at risk for obstructive uropath y to evaluate whether the cause of voiding dysfunction could be predic ted by the type (obstructive or irritative) or onset of symptoms. Mate rials and Methods: We evaluated 38 men with complaints of voiding dysf unction following a cerebrovascular accident. All patients were of the age when bladder outlet obstruction secondary to benign prostatic hyp erplasia would otherwise be prevalent. After a comprehensive history a nd physical examination, all patients underwent multichannel urodynami c studies at a medium fill rate (20 to 50 ml. per minute). Findings we re classified by the Abrams-Criffiths nomogram as obstruction, no obst ruction or equivocal. Results: Mean patient age was 70 years (range 54 to 87). Patients were grouped according to the presenting voiding com plaints (purely irritative in 42%, purely obstructive in 34% or mixed in 24%). In 34 patients (89%) the onset of symptoms paralleled the occ urrence of the cerebrovascular accident. Detrusor hyperreflexia was no ted in 82% of the patients. There was no statistically significant dif ference in the occurrence of detrusor hyperreflexia among the 3 sympto m groups (Fisher's exact test). Pressure-flow analysis clearly showed obstruction in 24 patients (63%), no obstruction in 9 (24%) and equivo cal results in 5 (13%) according to the nomogram. There was no statist ically significant difference in the incidence of obstruction among th e 3 symptom groups (Fisher's exact test). Conclusions: Presenting symp toms did not predict the urodynamic findings of bladder outlet obstruc tion or detrusor hyperreflexia. The significant incidence of onset of symptoms after stroke suggests that the cerebrovascular accident induc ed voiding dysfunction in the face of preexisting bladder outlet obstr uction may exacerbate the symptoms of the latter condition or vice ver sa.