Urinary Incontinence After Unilateral Hemispheric Stroke: A Neurologic-Epidemiologic Perspective

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Abstract
Life table analysis of urinary incontinence after unilateral hemispheric stroke in patients without previous history of incontinence shows the prevalence of incontinence at 1 month after stroke to range from 70% for patients with hemiplegia, proprioception deficit, and visual neglect to 10% for patients with pure motor hemiplegia. Classification of patients according to the presence of motor, proprioception deficit, and visual neglect at 1 month after stroke proved to be a sensitive (86%) and reasonably specific (70%) predictor of incontinence. Assessments of lesion size and location by CTT head scan parameters were not significantly different for continent versus incontinent patients. The cystometrogram and urogenital diaphragm electromyography studies showed "failure to store" type urge incontinence with increased detrusor irritability, decreased cortical awareness of bladder filling, and decreased voluntary control of the external sphincter. Detrusor-sphincter dyssynergy was not observed. Urinary tract infection and detrusor irritability were the only treatable causes for incontinence found. A postvoid residual urine volume less than 100 ml, normal microscopic urine analysis, and normal culture argue against further urologic evaluation. An anticholinergic trial can be attempted for symptomatic management of associated urge incontinence.

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