To investigate the urodynamic characteristics of lower urinary tract dysfunction (LUTD) during the rehabilitation period in elderly patients with ischemic stroke (IS). Based on the urodynamic study (UDS) results, corresponding treatment plans are formulated to assess the value of UDS in guiding clinical treatment, and to provide a reference for the clinical management of LUTD following IS.

This is a prospective study. A total of 117 patients with LUTD after IS (61-86 years old) admitted to the Hospital from November 2021 to November 2023 were included in this study. 84 patients who underwent urodynamic studies (UDS) were designated as the observation group, while 33 patients who did not receive UDS were placed in the control group. The control group received only basic urological treatment, which included voiding training and pelvic floor exercises. The treatment plan for the observation group was adjusted based on the UDS results: patients with detrusor overactivity (DO) were treated with oral tolterodine; those with non-reflexive detrusor leading to increased post-void residual (PVR) were given clean intermittent catheterization(CIC); patients with functional bladder outlet obstruction were treated with oral tamsulosin, and those with multiple conditions were managed with a combination of corresponding treatments. The treatment duration was three months. Both groups were assessed for quality of life (QOL) before treatment and three months after treatment to observe the therapeutic effects and patient satisfaction. The observation group underwent urodynamic testing before and after three months of treatment, and the changes in maximum urinary flow rate (Qmax), urine output, post-void residual (PVR), detrusor pressure at maximum flow rate (PdetQmax), and maximum bladder capacity (MCC) were compared. The bladder function status of the patients was evaluated based on UDS results, and the characteristics of their UDS changes were analyzed. This study was approved by the Ethics Committee of the Hospital (Ethics No. EC-024-076), and the subjects gave informed consent and signed informed consent.

1. UDS Results and Changes in UDS Before and After Treatment:
 In the observation group of 84 patients, there were 58 cases of DO (69%), 16 cases of weakened detrusor contraction (19%), 10 cases of detrusor areflexia (12%), and no detrusor-external sphincter dyscoordination was observed. After treatment, Qmax, urine output, and MCC significantly increased; PVR and PdetQmax significantly decreased (all P < 0.001).

2. QOL Score: 
At the time of enrollment, there was no significant difference in QOL scores between the two groups (P > 0.05). After treatment, QOL scores in both groups significantly decreased compared to before treatment (P < 0.001); further comparison between groups showed that the improvement in QOL scores in the observation group was significantly better than that in the control group (P < 0.001). It can be concluded that the treatment group had better therapeutic outcomes than the observation group. The QOL scores significantly decreased after the observation group received either drug treatment alone or CIC combined with drug treatment compared to before (P < 0.001).

3. Treatment Efficacy of Lower Urinary Tract Symptoms Guided by UDS: 
After 3 months of treatment based on UDS results in the observation group, out of 50 patients with frequent urination, 29 cases had their symptoms disappear; out of 49 patients with urgency, 29 cases had their symptoms disappear; out of 28 patients with urinary incontinence, 15 cases had their symptoms disappear; out of 27 patients with dysuria, 15 cases had their symptoms disappear; and out of 24 patients with urinary retention, 16 cases had their symptoms disappear. There was a significant improvement in lower urinary tract symptoms after treatment compared to before (P < 0.05).After three months of basic urinary treatment in the control group, among the 19 patients with frequent urination, 6 cases had symptom resolution; among the 18 patients with urinary urgency, 8 cases had symptom resolution; among the 11 patients with urinary incontinence, 5 cases had symptom resolution; among the 10 patients with difficult urination, 5 cases had symptom resolution; and among the 9 patients with urinary retention, 3 cases had symptom resolution. There was no significant difference in the statistical analysis of lower urinary tract symptoms after treatment compared to before treatment (P > 0.05). It can be concluded that the treatment group had better therapeutic outcomes than the observation group.

1. The results of this study showed that the most common change of UDS in elderly LUTD patients in the rehabilitation period after IS is DO, which may be due to the damage of the detrusor center of the brain or its conducting fibers. The frontal cortex has long been considered the higher center for urination (primarily bladder suppression) because lesions in the frontal cortex, such as the prefrontal cortex, medial superior/middle frontal gyrus, anterior cingulate gyrus, and auxiliary motor area, cause DO.

2. Under the guidance of UDS, the lower urinary tract symptoms of the patients were significantly improved after treatment, and the improvement of the observation group was significantly better than that of the control group. Qmax, urine output, PVR, PdetQmax, MCC and QOL scores were significantly improved, patient satisfaction was improved, and quality of life was significantly improved. This indicates that UDS is an effective tool to evaluate LUTD in the rehabilitation period after IS in the elderly, which can be used to guide rational drug use, and has important guiding value to improve the therapeutic effect and the quality of life of patients.

In the rehabilitation period after stroke in the elderly, lower urinary tract dysfunction (LUTD) is primarily manifested as detrusor overactivity (DO) in UDS, with a minority of cases exhibiting detrusor contractility weakness or even absence of reflex. After treatment based on the UDS results, there is a significant improvement in clinical symptoms, UDS findings, and quality of life for these patients. UDS is an effective tool for assessing the treatment of LUTD in the rehabilitation period after stroke in the elderly.