1443 - Exploring The Effectiveness of Bethanechol In Managing Urinary Retention In Patients With Acute Stroke: A Single-Center Observational Study

Objectives: Urinary retention is a common stroke sequela associated with worse functional outcomes and higher mortality. While definitively managed by catheterization, medications such as bethanechol are also frequently used to assist with bladder emptying despite sparse evidence. Our goal is to assess for an association between bethanechol initiation and retention improvement.

Design: This study was a single-center retrospective cohort study conducted through chart review at a freestanding acute inpatient rehabilitation facility. It included adult patients admitted between July 2012 and July 2022 who had experienced acute ischemic or hemorrhagic strokes resulting in urinary retention (defined as post-void residual volume [PVR] or catheterization volume > 350 milliliters) and were subjected to a trial of bethanechol. Exclusion criteria encompassed patients with a history of prior urinary retention, chronic indwelling urinary catheter use, end-stage renal disease, benign prostatic hyperplasia, cancer of the brain or spinal cord, or prostate cancer.

Results: Of the 100 patients initially selected, 40 were excluded, leaving a final sample of 60 patients. The average age of the patients was 65.5±14.4 years. 38.3% were male and 61.7% were female. 78.3% of patients had a history of hypertension, 30.5% had a history of diabetes, 36.7% had a history of hyperlipidemia, and 13.3% had a history of atrial fibrillation. 57.6% of patients had an ischemic stroke, and 42.3% had a hemorrhagic stroke. Bethanechol was initiated after an average of 11.8±8.4 days. The average PVR/catheterization volumes were 499.5±154.1 ml prior to bethanechol initiation and 303.7±143.9 ml during bethanechol administration. Over the course of 20 days after bethanechol initiation, approximately 40% of patients experienced a resolution of urinary retention.

Conclusions: This study found an association between the initiation of bethanechol and a reduction in PVR/catheterization volumes with an approximate 40% resolution in urinary retention. Bethanechol may be useful in the treatment of urinary retention following acute stroke.