From the Guidelines
Post-stroke urinary retention should be initially managed with intermittent catheterization to ensure complete bladder emptying and reduce the risk of infection. This approach is recommended as the first-line treatment for urinary retention in patients who have experienced a stroke, as it allows for the bladder to be emptied completely while minimizing the risk of urinary tract infections associated with indwelling catheters 1.
Key Considerations
- Patients with stroke should be observed for voiding after hospital presentation, and those with urinary retention or incontinence should undergo screening via bladder scan or straight catheterization 1.
- Assessment of bladder function, including a history of urological issues before the stroke, is crucial for guiding treatment decisions 1.
- Removal of the Foley catheter within 24 hours after admission for acute stroke is recommended to reduce the risk of infection and promote bladder function recovery 1.
Treatment Options
- Intermittent catheterization for initial management of urinary retention
- Prompted voiding and pelvic floor muscle training as non-pharmacological approaches to improve bladder control
- Potential use of medications such as alpha-blockers, cholinergic agents, or baclofen in specific cases, although these are not directly mentioned in the most recent and highest quality evidence provided 1.
Prioritizing Patient Outcomes
The primary goal in managing post-stroke urinary retention is to minimize morbidity, mortality, and improve the quality of life for patients. By prioritizing intermittent catheterization as the initial management strategy, healthcare providers can help reduce the risk of complications such as urinary tract infections and promote more effective bladder emptying, ultimately contributing to better patient outcomes.
From the Research
Treatment Options for Post-Stroke Urinary Retention
- The treatment options for post-stroke urinary retention include urinary catheterization, particularly if acute, in combination with discontinuation or a reduction in dose of the causal drug 2.
- Tamsulosin appears to be helpful in the management of men with acute urinary retention, with the majority of men able to avoid surgery after temporary catheter drainage 3.
- Behavioural interventions, such as timed voiding, may reduce the mean number of incontinent episodes in 24 hours, although the evidence is of low quality 4.
- Specialised professional input interventions, such as structured assessment and management by continence nurse practitioners, may make little or no difference to the number of people continent three months after treatment 4.
- Complementary therapy, including traditional acupuncture, electroacupuncture, and ginger-salt-partitioned moxibustion plus routine acupuncture, may increase the number of participants continent after treatment 4.
- Physical therapy, such as transcutaneous electrical nerve stimulation (TENS), may reduce the mean number of incontinent episodes in 24 hours and improve overall functional ability 4.
Pharmacological Interventions
- There is no evidence that oestrogen therapy makes a difference to the mean number of incontinent episodes per week in mild incontinence or severe incontinence 4.
- Tamsulosin has been shown to be effective in the management of men with acute urinary retention, with a significant reduction in postvoid residual urine volume and improvement in symptom scores 3.
Other Interventions
- Intermittent catheterization may be necessary in some patients with post-stroke urinary retention, particularly those who are unable to void spontaneously 5.
- The use of alpha-blockers, such as tamsulosin, may be beneficial in the management of post-stroke urinary retention, particularly in men with benign prostatic hyperplasia 3.