Sex-specific independent risk factors of urinary incontinence in acute stroke patients: a multi-centre registry-based cohort study

Background
The presence of urinary incontinence (UI) in acute stroke patients indicates poor outcomes in men and women. However, there is a paucity and inconsistency of data on UI risk factors in this group and hence we conducted a sex-specific analysis to identify risk factors.

Methods
Data were collected prospectively (2014–2016) from the Sentinel Stroke National Audit Program for patients admitted to four UK hyperacute stroke units. Relevant risk factors for UI were determined by stepwise multivariable logistic regression, presented as odds ratios (OR) and 95% confidence intervals (CI).

Results
The mean (±SD) age of UI onset in men (73.9 year ± 13.1; n = 1593) was significantly earlier than for women (79.8 year ± 12.9; n = 1591: p < 0.001). Older age between 70 and 79 year in men (OR = 1.61: CI = 1.24–2.10) and women (OR = 1.55: CI = 1.12–2.15), or ≥80 year in men (OR = 2.19: CI = 1.71–2.81), and women (OR = 2.07: CI = 1.57–2.74)–reference: <70 year–both predicted UI. In addition, intracranial hemorrhage (reference: acute ischemic stroke) in men (OR = 1.64: CI = 1.22–2.20) and women (OR = 1.75: CI = 1.30–2.34); and prestroke disability (mRS scores ≥ 4) in men (OR = 1.90: CI = 1.02–3.5) and women (OR = 1.62: CI = 1.05–2.49) (reference: mRS scores < 4); and stroke severity at admission: NIHSS scores = 5–15 in men (OR = 1.50: CI = 1.20–1.88) and women (OR = 1.72: CI = 1.37–2.16), and NIHSS scores = 16–42 in men (OR = 4.68: CI = 3.20–6.85) and women (OR = 3.89: CI = 2.82–5.37) (reference: NIHSS scores = 0–4) were also significant. Factors not selected were: a history of congestive heart failure, hypertension, atrial fibrillation, diabetes and previous stroke.

Conclusions
We have identified similar risk factors for UI after stroke in men and women including age >70 year, intracranial hemorrhage, prestroke disability and stroke severity.