Ann Rehabil Med.  2012 Apr;36(2):248-253. 10.5535/arm.2012.36.2.248.

The Relation between Postvoid Residual and Occurrence of Urinary Tract Infection after Stroke in Rehabilitation Unit

• Kim BR
• Lim JH
• Lee SA
• Kim JH
• Koh SE
• Lee IS
• Jung H
• Lee J

• KMID: 2266764
• DOI: http://doi.org/10.5535/arm.2012.36.2.248

Abstract

OBJECTIVE
To determine the relation between postvoid residual (PVR) and the occurrence of urinary tract infection (UTI) in stroke patients. METHOD: One hundred and eighty-eight stroke patients who were admitted to an inpatient rehabilitation unit and who did not have UTI on admission (105 males, 83 females, mean age 67.1 years) were included in this study. The PVR was measured 3 times within 72 hours after admission. Mean PVR, demographic variables, K-MMSE (Korean Mini-Mental State Examination), initial K-MBI (Korean Modified Barthel Index), Foley catheter indwelling time and stroke type were defined and the relation to the occurrence of UTI was analyzed.
RESULTS
UTI occurred in 74 patients (39.4%) during admission to the rehabilitation unit. There were significant differences between the UTI and non-UTI groups in K-MMSE, K-MBI, Foley catheter indwelling time (p<0.01). However, age, gender, stroke location and type were not associated. The occurrence of UTI was 4.87 times higher in the patients with a mean PVR over 100 ml than in those with a mean PVR <100 ml. The mean PVR was 106.5 ml in the UTI group, while it was 62.7 ml in the non-UTI group (p<0.01). PVR was not associated with age.
CONCLUSION
The UTI rate is higher when the mean PVR is over 100 ml irrespective of gender and age. Close monitoring of PVR and appropriate intervention is needed to reduce the occurrence of UTI in stroke patients.

Keyword

Urinary tract infection; Postvoid residual; Stroke

MeSH Terms

Catheters
Female
Humans
Inpatients
Male
Stroke
Urinary Tract
Urinary Tract Infections

Figure

• 

  Fig. 1 Comparison with PVR volume and incidence of UTI according to sex. *p<0.01 by Mann-Whitney test.

• 

  Fig. 2 Comparison of PVR volume and incidence of UTI according to age. *p<0.01, †p<0.05 by Mann-Whitney test.

Reference

1. Dromerick AW, Edwards DF. Relation of postvoid residual to urinary tract infection during stroke rehabilitation. Arch Phys Med Rehabil. 2003; 84:1369–1372. PMID: 13680576.

2. Garrett VE, Scott JA, Costich J, Aubrey DL, Gross J. Bladder emptying assessment in stroke patients. Arch Phys Med Rehabil. 1989; 70:41–43. PMID: 2916918.

3. Gelber DA, Good DC, Laven LJ, Verhulst SJ. Causes of urinary incontinence after acute hemispheric stroke. Stroke. 1993; 24:378–382. PMID: 8446973.

4. Ween JE, Alexander MP, D'Esposito M, Roberts M. Incontinence after stroke in a rehabilitation setting: outcome associations and predictive factors. Neurology. 1996; 47:659–663. PMID: 8797460.

5. Hung JW, Tsay TH, Chang HW, Leong CP, Lau YC. Incidence and risk factors of medical complications during inpatient stroke rehabilitation. Chang Gung Med J. 2005; 28:31–38. PMID: 15804146.

6. Roth EJ, Lovell L, Harvey RL, Heinemann AW, Semik P, Diaz S. Incidence of and risk factors for medical complications during stroke rehabilitation. Stroke. 2001; 32:523–529. PMID: 11157192.

7. Dromerick A, Reding M. Medical and neurological complications during inpatient stroke rehabilitation. Stroke. 1994; 25:358–361. PMID: 8303745.

8. Yang CY, Choi SM, Kim DY, Ko JY, Jeon PS. The trends of urinary tract infection in patients with neurogenic bladder. J Korean Acad Rehabil Med. 1997; 21:689–695.

9. Barnett BJ, Stephens DS. Urinary tract infection: an overview. Am J Med Sci. 1997; 314:245–249. PMID: 9332263.

10. Flaherty PJ, Liljestrand JS, O'Brien TF. Urinary tract infections in an American rehabilitation hospital. J Hosp Infect. 1984; 5:75–80. PMID: 6084690.

11. Cardenas DD, Hooton TM. Urinary tract infection in persons with spinal cord injury. Arch Phys Med Rehabil. 1995; 76:272–280. PMID: 7717822.

12. Hampson SJ, Noble JG, Rickards D, Milroy EJ. Does residual urine predispose to urinary tract infection? Br J Urol. 1992; 70:506–508. PMID: 1467855.

13. Kim SH, Chong SY, Chung JS, Choi YC. Effect of postures on residual urine following catheterization in spinal cord injured patients. J Korean Acad Rehabil Med. 1997; 21:493–499.

14. Lukacz ES, DuHamel E, Menefee SA, Luber KM. Elevated postvoid residual in women with pelvic floor disorders: prevalence and associated risk factors. Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18:397–400. PMID: 16804634.

15. Merritt JL. Residual urine volume: correlate of urinary tract infection in patients with spinal cord injury. Arch Phys Med Rehabil. 1981; 62:558–561. PMID: 7316711.

16. Griffiths DJ, Harrison G, Moore K, McCracken P. Variability of post-void residual urine volume in the elderly. Urol Res. 1996; 24:23–26. PMID: 8966837.

17. Brown JS. Diabetic cystopathy--what does it mean? J Urol. 2009; 181:13–14. PMID: 19012909.

18. Drake MJ, Nixon PM, Crew JP. Drug-induced bladder and urinary disorders. Incidence, prevention and management. Drug Saf. 1998; 19:45–55. PMID: 9673857.

19. Dania D. Braddom RL, editor. Management of bladder dysfunction. Physical medicine and rehabilitation. 2007. 3rd ed. Philadelphia: Saunders.

20. Knapp PM Jr. Identifying and treating urinary incontinence. The crucial role of the primary care physician. Postgrad Med. 1998; 103:279–280. PMID: 9553601.

21. Da Silva FC. Benign prostatic hyperplasia: natural evolution versus medical treatment. Eur Urol. 1997; 32(Suppl 2):34–37. PMID: 9248811.

22. Naslund MJ, Gilsenan AW, Midkiff KD, Bown A, Wolford ET, Wang J. Prevalence of lower urinary tract symptoms and prostate enlargement in the primary care setting. Int J Clin Pract. 2007; 61:1437–1445. PMID: 17686091.

23. Hershkovitz A, Beloosesky Y, Pomp N, Brill S. Is routine screening for urinary tract infection in rehabilitation day-hospital elderly patients necessary? Arch Gerontol Geriatr. 2002; 34:29–36. PMID: 14764308.

24. Marshburn PB, Carr BR. Hormone replacement therapy. Protection against the consequences of menopause. Postgrad Med. 1992; 92:145–148. PMID: 1528813.

25. Stern JA, Hsieh YC, Schaeffer AJ. Residual urine in an elderly female population: novel implications for oral estrogen replacement and impact on recurrent urinary tract infection. J Urol. 2004; 171:768–770. PMID: 14713807.

26. Burney TL, Senapati M, Desai S, Choudhary ST, Badlani GH. Acute cerebrovascular accident and lower urinary tract dysfunction: a prospective correlation of the site of brain injury with urodynamic findings. J Urol. 1996; 156:1748–1750. PMID: 8863586.

27. Kong KH, Young S. Incidence and outcome of post-stroke urinary retention: a prospective study. Arch Phys Med Rehabil. 2000; 81:1464–1467. PMID: 11083349.