Bladder assessment and management in acute stroke patients

Introduction: Acute stroke patients are at high risk for morbidity and mortality. Their many comorbidities, including cardiovascular and renal diseases, require the attention of multiple medical and surgical teams in a compressed amount of time. Peri-stroke urinary retention can be avoided with an indwelling catheter. However, placement of a urinary catheter prolongs door-to-revascularization time, can lead to traumatic bleeding, and increases the risk of catheter-associated urinary tract infection. We performed a quality improvement project to quantify the number of interventional thrombectomy stroke patients undergoing bladder drainage and track potential adverse effects. Methods: We completed a retrospective chart review of acute stroke patients who required emergency endovascular thrombectomy between January 5, 2021, and November 1, 2021, at our institution. Our aim was to analyze our current practice of urinary management for acute stroke patients requiring interventional thrombectomy. Results: We identified 53 patients with acute stroke that required interventional thrombectomy. An indwelling urinary catheter was inserted for 34 patients (64.2%) in the emergency department (4 [11.8%]), the interventional radiology suite (12 [35.3%]), or the postprocedural neurointensive care unit (18 [52.9%]). Seventeen patients (32.1%) received a portable bladder ultrasonography in the emergency department (mean volume, 342 mL) or the neurointensive care unit (mean volume, 433 mL). Two patients (3.8%), both catheterized, developed symptoms of urinary tract infection within 30 days. Conclusions: No definitive treatment algorithm to assist in determining who should receive a urinary catheter could be discerned from our initial data. Further investigation is needed to evaluate the role of portable bladder ultrasonography in the decision to catheterize ischemic stroke patients.