Traumatic brain injury and bladder function: From acute to chronic phase. A literature review

Abstract

Traumatic brain injury (TBI) can induce a coma and directly affect the pathways that help control lower urinary tract (LUT) function. This paper reviews the clinical and urodynamic data from the literature on LUT function after TBI in the acute, rehabilitation and chronic phases. The number of papers available on LUT function after TBI is very limited, but the studies have been well conducted, and the sample size is acceptable. The interpretation of reported data is complex due to heterogeneity in the items studied and the level of detail. During the early phase, indwelling catheters are needed for critical care, but spontaneous voiding is possible in most patients as soon as the catheter can be removed. The ability to void is primarily independent of the Glasgow Coma Scale value. During rehabilitation, spontaneous voiding is observed in the majority, but re-learning of voluntary control may be needed. In the follow-up, complete recovery of continence and voiding is possible, but overactive bladder and other LUT symptoms (LUTS) have been described. The data show that afferent and sensory functions related to the LUT remain active in many TBI patients, making long-term use of indwelling catheters unnecessary. There are no studies that follow the evolution in the same patient over a long period. Urodynamic studies show that LUT function varies after TBI and that variables such as age, previous dysuria, diabetes and local anatomic pathologies can also influence the outcome. Personalized management after an evaluation is therefore needed in TBI patients.