Urodynamic Evaluation of Urinary Disturbances following Traumatic Brain Injury

Abstract

Objectives: To identify the incidence and the type of voiding dysfunction by doing urodynamic studies (UDS) in head injury patients. The purpose of this paper is to present our findings and promote research in this field. Patients and Methods: A prospective study was conducted recruiting patients sustaining head injuries with positive CT scan findings. Clinical and radiological evaluation was done. Patients then underwent standardized UDS. The urodynamic findings were correlated with outcome and analyzed. Results: Three out of 11 patients (27.3%) had unstable bladder with multiple involuntary contractions in the filling phase. All of them had significant contusions in the right frontal region and 2 of them had subarachnoid hemorrhage. All of these patients had normal proprioception, voluntary detrusor contractions and nil post-void residue. Two out of the 3 patients had catheter in situ and 1 patient had complaints of frequency and urgency. At 1 year of follow-up, all 3 patients had a normal voiding pattern and the upper tracts were normal on ultrasound in all patients. Conclusions: Voiding dysfunction is a significant problem in patients with head injury. Bladder hyperreflexia is seen in patients with injuries above the pontine micturition center. The voiding abnormality has good prognosis and resolves spontaneously. Treatment in the acute phase may require anticholinergics for a few months.