There have been no previous studies of urinary symptoms in patients with traumatic frontal intracerebral hemorrhage. The purpose of this work was to provide first insights into the potential role of traumatic frontal intracerebral hemorrhage in the development of urinary symptoms. This condition is known to cause compression in and around the prefrontal cortex, and we wanted to examine its effect on the micturition center.
Patients with voiding dysfunction (n = 176) were assessed for lower urinary tract symptoms using the International Prostate Symptom Score (IPSS). Out of 176 patients, 52 symptomatic patients with voiding difficulties underwent urodynamic testing. All patients with traumatic frontal intracerebral hemorrhage were treated at the University Medical Center Tuebingen, Germany, and the Azad University of Medical Sciences in Tehran, Iran, between 2017 and 2020. Lower urinary tract symptoms (LUTS) were documented in patients with compression of the frontal lobe due to local hemorrhage. All patients routinely performed Brain CT scans. Brain magnetic resonance (MRI) images of the patients with suspicion of diffuse axonal injuries were additionally performed. Out of 176 treated patients (median age of 49 years), 52 patients with voiding difficulties were evaluated.
Urodynamic testing of 52 symptomatic patients revealed detrusor overactivity in 25 (48%), low-compliance bladder in 4 (7.7%), detrusor-sphincter dyssynergia in 20 (38%), and uninhibited sphincter relaxation in 11 patients (21%). There was no significant correlation between the volume of hemorrhage and urinary symptoms (p=0.203, Spearman q=0.726). Frontal intracerebral hemorrhage compressing the pre-frontal cortex influences the micturition center and is responsible for lower urinary tract symptoms.
Hemorrhage of the right or left frontal lobe does have a direct relationship with incontinence which completely disappeared in 85% of the patients within 9 months.