From the Guidelines
Approximately 15% of patients with minor stroke require urological follow-up in the chronic phase of stroke. This need for urological care stems from the neurological damage that can affect bladder control and urinary function, even in cases of minor stroke. Patients may experience urinary incontinence, retention, frequency, or urgency that persists beyond the acute recovery phase. These urological complications often develop as the patient progresses from hospital care to rehabilitation and community living. According to 1, poststroke bladder and bowel dysfunction affects approximately 25% to 50% of stroke survivors, with urinary retention occurring in only 15% of patients by 1 year after stroke.
Key factors to consider in the management of poststroke urinary incontinence include:
- Determining the stroke survivor’s premorbid bladder and bowel patterns
- Monitoring bladder emptying to prevent urinary tract infections
- Addressing poststroke urinary incontinence through a stepwise approach, including behavioral bladder-training programs and medication as needed
- Considering surgical intervention as a last alternative
Primary care providers should screen for urinary symptoms during follow-up visits after minor stroke, as patients may not volunteer this information due to embarrassment. Treatment options include behavioral modifications, pelvic floor exercises, antimuscarinic medications like oxybutynin or solifenacin for overactive bladder, or alpha-blockers such as tamsulosin for retention issues. Prompt referral to urology is warranted when symptoms persist despite initial management or when complications like recurrent urinary tract infections develop, as supported by the guidelines outlined in 1.
From the Research
Urological Follow-up in Minor Stroke Patients
- The provided studies do not directly address the percentage of patients with minor stroke who require urological follow-up in the chronic phase of stroke 2, 3, 4, 5, 6.
- However, it is mentioned that bladder dysfunction is common initially after stroke, but improvements in voiding occur after the first few weeks 2.
- Additionally, incontinence can affect over half of stroke victims in the initial post-stroke phase, but there is no specific information on the chronic phase 3.
- The studies focus on various aspects of stroke, including causes, clinical features, management, and follow-up care, but do not provide a clear answer to the question 4, 5, 6.
- One study highlights the importance of addressing residual problems, including psychological, cognitive, and physical impairments, in patients with minor stroke, but does not specifically mention urological follow-up 6.