Association between switching prescribed drugs for lower urinary tract symptoms and independence of urination in post-stroke patients: A retrospective cohort study

Koyomi Sumiya; Miho Shogenji; Yasunori Ikenaga; Yoru Ogawa; Kohei Hirako; Arimi Fujita; Tsutomu Shimada; Masako Hashimoto; Akio Masuda; Takehito Nagamoto; Ikumi Tamai; Hisayuki Ogura; Tadashi Toyama; Takashi Wada; Yoshimichi Sai

doi:10.1016/j.jstrokecerebrovasdis.2023.107419

Association between switching prescribed drugs for lower urinary tract symptoms and independence of urination in post-stroke patients: A retrospective cohort study

J Stroke Cerebrovasc Dis. 2023 Dec;32(12):107419. doi: 10.1016/j.jstrokecerebrovasdis.2023.107419. Epub 2023 Oct 14.

Authors

Koyomi Sumiya¹, Miho Shogenji², Yasunori Ikenaga³, Yoru Ogawa⁴, Kohei Hirako⁵, Arimi Fujita⁶, Tsutomu Shimada⁷, Masako Hashimoto⁸, Akio Masuda⁹, Takehito Nagamoto⁹, Ikumi Tamai¹⁰, Hisayuki Ogura¹¹, Tadashi Toyama¹¹, Takashi Wada¹², Yoshimichi Sai¹³

Affiliations

¹ Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.
² Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan.
³ Department of Rehabilitation Medicine, Yawata Medical Center, Ishikawa, Japan; Council of Kaga Local Stroke Network, South Ishikawa, Japan.
⁴ Council of Kaga Local Stroke Network, South Ishikawa, Japan; Department of Pharmacy, Komatsu Municipal Hospital, Ishikawa, Japan.
⁵ Frontier Science and Social Co-creation Initiative, Kanazawa University, Ishikawa, Japan; The Establishment Preparation Office for The Faculty of Interdisciplinary Economics, Kinjo University, Ishikawa, Japan.
⁶ Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan.
⁷ Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan. Electronic address: t-shimada@staff.kanazawa-u.ac.jp.
⁸ Temari Pharmacy, Ishikawa, Japan.
⁹ Komeya Pharmacy, Ishikawa, Japan.
¹⁰ Division of Pharmacy, Graduate School of Pharmaceutical Sciences, Kanazawa University, Ishikawa, Japan; AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan.
¹¹ AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan; Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan.
¹² Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan.
¹³ Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan; AI Hospital/Macro Signal Dynamics Research and Development Center, Kanazawa University, Ishikawa, Japan.

PMID: 37839304
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107419

Abstract

Objectives: Stroke patients frequently exhibit loss of independence of urination, and their lower urinary tract symptoms change with the phase of stroke. However, it is unclear whether switching prescribed drugs for lower urinary tract symptoms during hospitalization from acute care wards to convalescence rehabilitation wards affects patients' independence of urination at discharge. It is also unclear whether the impact of switching varies by stroke type. This retrospective cohort study aimed to examine these issues.

Materials and methods: We analyzed 990 patients registered in the Kaga Regional Cooperation Clinical Pathway for Stroke database during 2015-2019. Prescriptions for lower urinary tract symptoms from pre-onset to convalescence rehabilitation were surveyed. Logistic regression analysis was performed to examine the association between switching drugs and independence of urination based on bladder management and voiding location at discharge. Stroke types were also examined in subgroup analyses.

Results: About 21 % of patients had their lower urinary tract symptoms prescriptions switched during hospitalization. Switching was positively associated with independence of bladder management (odds ratio 1.65, 95 % confidence interval 1.07 to 2.49) and voiding location (odds ratio 2.72, 95 % confidence interval 1.72 to 4.37). Similar associations were observed in different stroke types.

Conclusions: Approximately 20 % of patients had their lower urinary tract symptoms medications switched upon transfer from acute to convalescence rehabilitation wards. Switching was significantly associated with improved urinary independence at discharge. Consistent results were observed across different stroke types, suggesting that switching medications contributes to urinary independence after stroke, regardless of the etiology or severity of stroke.

Keywords: Activities of daily living; Lower urinary tract symptoms; Stroke rehabilitation; Urinary medication.

MeSH terms

Convalescence
Humans
Lower Urinary Tract Symptoms* / diagnosis
Lower Urinary Tract Symptoms* / drug therapy
Lower Urinary Tract Symptoms* / etiology
Retrospective Studies
Stroke Rehabilitation*
Stroke* / complications
Stroke* / diagnosis
Stroke* / drug therapy
Urination