Bladder continence management in adult acquired brain injury.
OBJECTIVE
Persistence of urinary incontinence post acquired brain injury (ABI) carries important prognostic significance. We undertook to document the incidence of urinary incontinence, its management and complications in rehabilitation inpatients following ABI and to assess adherence to post ABI bladder management guidelines.


METHODS
A retrospective chart survey of a convenience sample of consecutive admissions to two adult neurorehabilitation units Forster Green Hospital, Belfast, and the Scottish Brain Injury Rehabilitation Service, Edinburgh (SBIRSE). Bladder continence and management on transfer to and discharge from rehabilitation, trial removal of catheter, use of bladder drill, ultrasound investigation, anticholinergic medication and complications were recorded.


RESULTS
One hundred and forty six patients were identified. Seventy-seven (52.7%) were independent and continent of urine at rehabilitation admission and 109 (74.7%) on discharge. In all, 13 patients had urinary tract infection, 7 had urethral stricture and 1 developed haematuria whilst catheterised. Ultrasound of renal tracts was underused. Trial removal of catheter after transfer to rehabilitation occurred at a median of 10 days.


CONCLUSIONS
Urinary continence was achieved in almost half of incontinent ABI patients during rehabilitation. There is potential for increased use of investigation of the renal tracts. Rehabilitation physicians should consider urethral stricture in the management of continence post ABI.
Regional Acquired Brain Injury Unit, Musgrave Park Hospital , Belfast , UK and.
Sheena B
SB
Caldwell
Jennifer S
JS
Wilson
Daniel
D
Smith
John P
JP
McCann
Ian K
IK
Walsh
D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D002985:Clinical Protocols; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008297:Male; D020380:Needs Assessment; D011379:Prognosis; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014463:Ultrasonography; D006113:United Kingdom; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000503:physiopathology; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000534:rehabilitation
Brain injury; continence; urinary tract infection