Urinary Issues After Brain Injury: A Father's Journey

Father had a car accident, and after the catheter was removed, he is unable to urinate?

Dear Dr.
Hsu,
My father, who is 55 years old, was involved in a car accident three months ago, during which he sustained a head injury that resulted in a subdural hematoma on the right side of his brain.
He underwent two successful surgeries; however, the blood clot has compressed the motor neurons in the right hemisphere, leading to paralysis of the left side of his body.
He has been undergoing rehabilitation since his discharge, and after nearly two months, he has shown slight improvement in the movement of his left limbs, although they remain somewhat uncoordinated.
He requires a walker for assistance while walking.
Additionally, he has had a urinary catheter in place for nearly three months.
During his one-month hospital stay, there was an attempt to remove the catheter, but he was unable to urinate.
Recently, we took him to the hospital for urodynamic testing, but he still could not urinate.
I would like to ask you, Dr.
Hsu, what condition my father is experiencing.
Is it due to nerve damage from the head injury, or could it be a result of long-term catheterization leading to loss of bladder muscle function?
Should we initiate catheter training for my father? If so, how long should the training last? When we remove the catheter for 2-3 hours, how long should we wait before re-cathing? This issue has been troubling me for a long time, and I am very concerned about my father having to live with a urinary bag.
I sincerely hope you can provide some guidance.
Thank you very much!

Aru, 20~29 year old female. Ask Date: 2009/01/06

Dr. Xu Weikai reply Urology

Hello, after a stroke, some individuals may experience urinary issues.
If the affected area is in the urinary control center, the difficulties with urination will be more pronounced.
Three months after your father's illness is considered a short duration.
Generally, when brain injury affects urination, the assessment period is at least six months.
In other words, it typically takes at least six months to see significant improvement.
Long-term placement of a urinary catheter will not affect bladder function unless there is an infection.

Additionally, urodynamics can help assess the recovery of bladder nerves; if the pressure is adequate, there may be an opportunity to remove the catheter.
Bladder training is often based on time intervals for convenience, but this is not the best approach.
I personally recommend using the volume of urine as a measure: it is advisable to aim for a urine volume of about 200 to 400 cc each time the catheter is released, avoiding both too little and too much.
This allows the bladder to expand appropriately without overdistension, which is the correct and effective way to train the bladder.

As for when to release the catheter, family members should gradually adjust the timing based on fluid intake.
If there are any unclear points, feel free to ask again for further discussion and research.

Sincerely,
Dr.
Hsu Wei-Kai
Department of Urology, Taitung Hospital, Ministry of Health and Welfare

Reply Date: 2009/01/06

More Info

Your father's situation is indeed complex and concerning, especially considering the significant brain injury he sustained from the motorcycle accident. The issues he is facing with urinary function can be attributed to a combination of factors related to his brain injury and the prolonged use of a urinary catheter.

Firstly, brain injuries, particularly those affecting the right hemisphere, can lead to various neurological deficits, including motor control issues and cognitive impairments. The right side of the brain is often associated with spatial awareness and the control of the left side of the body. Given that your father has experienced left-sided paralysis, it is likely that the injury has affected the areas of the brain responsible for bladder control and coordination. This can lead to difficulties in initiating urination, which may explain why he has been unable to void when the catheter was removed.

Additionally, prolonged catheterization can lead to a condition known as "catheter-associated urinary retention." When a catheter is in place for an extended period, the bladder muscles can become less responsive, leading to a loss of normal bladder function. This means that even if the neurological pathways are intact, the bladder may not be able to contract effectively to allow for urination. This is a common issue in patients who have had long-term catheterization, and it can complicate the recovery process.

Regarding urinary training, it is essential to approach this carefully. Urinary training typically involves gradually re-establishing the bladder's ability to function without a catheter. This can include scheduled voiding, where the patient is encouraged to attempt to urinate at regular intervals. The duration of this training can vary significantly from person to person, depending on the extent of the injury and the individual’s overall health. It may take several weeks to months for some patients to regain sufficient bladder control.

In terms of the practical aspects of urinary training, it is generally recommended to remove the catheter for a few hours at a time, allowing the bladder to fill and then encouraging the patient to attempt to void. If successful, you can gradually increase the time between attempts. If your father is unable to void after a few hours, the catheter may need to be reinserted temporarily to prevent bladder overdistension.

It is crucial to work closely with a healthcare provider, such as a urologist or a rehabilitation specialist, who can provide tailored advice and monitor your father's progress. They may suggest additional interventions, such as bladder training exercises, medications to stimulate bladder function, or even pelvic floor therapy, depending on his specific needs.

In summary, your father's urinary issues are likely a result of both the neurological damage from his brain injury and the effects of prolonged catheter use. A structured approach to urinary training, under the guidance of healthcare professionals, can help improve his situation over time. It is understandable to be concerned about his quality of life, and seeking support from medical professionals will be key in navigating this challenging journey.

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