Voiding and sexual dysfunction after cerebrovascular accidents

We provide an up-to-date review of the urological manifestations of cerebrovascular accidents and their management, including sexual manifestations.

We performed a comprehensive MEDLINE search for peer reviewed articles using key words and incorporated these data with our experience with the treatment of patients in an acute stroke unit, rehabilitation unit and ambulatory care center.

The knowledge of urological dysfunction after stroke is based largely on the evaluation of symptomatic patients. The predominant symptoms are urinary frequency, urgency and urge incontinence. Time after stroke has a significant influence on urological findings. Detrusor hyperreflexia is the most common urodynamic finding. Whereas the site and size of the stroke clearly have an influence on urological findings, to our knowledge the effect of the involved hemisphere is unclear. Urinary incontinence as an initial presentation in acute stroke is associated with a high mortality rate. Sexual dysfunction is common in men and women. Co-morbid conditions, such as diabetes mellitus, benign prostatic hyperplasia and urethral incontinence, may complicate evaluation and management.

A stroke has a profound effect on lower urinary tract function, sometimes resulting in significant morbidity. In well rehabilitated patients sexual dysfunction should be assessed and treatment may be considered to improve quality of life with safety. An overall conservative approach to management is recommended in the initial 3 to 6 months since improvement is common with time.