Urinary catheterisation in acute stroke patients treated with intravenous thrombolysis

Bladder dysfunction may occur in acute stroke patients and as a consequence the risk of urinary retention, incontinence and urinary tract infections increases. The literature is sparse regarding occurrence of bladder dysfunction in acute stroke and if catheterization should be performed to prevent bladder overdistension in acute stroke thrombolysis. The aim of this study was to investigate the safety of implementing a new selective and "watchful waiting strategy" for intermittent catheterization during acute stroke thrombolysis. From November 2018 to June 2019, we conducted a prospective cohort study before and after implementing (in March 2019) a selective and watchful waiting strategy for intermittent catheterization. Data were collected on nurse-administered registration forms for ischemic stroke patients treated with thrombolysis. In both periods urogenital complications were registered. We found no significant differences between period 1 (before) and 2 (after) in the occurrence of urinary tract infections and/or macroscopic urogenital bleeding episodes. However, for developing blood in the 24 hour urine analysis we found a significant reduction in period 2 compared to period 1, 8 (23%) vs 3 (7%) respectively. Applying a selective and watchful waiting strategy towards urinary catheterization in acute ischemic stroke patients treated with intravenous thrombolysis did not increase the risk of urogenital complications, and the discomfort associated with catheterization was limited to fewer patients.