Detrusor after-contraction is associated with bladder outlet obstruction

Abstract

Aims The aims of this study were to determine how we can differentiate detrusor after-contraction (DAC) from artifacts, and to understand the clinical implications and significance of DAC. Materials and Methods A retrospective analysis was performed on 2,309 patients with neurogenic or non-neurogenic voiding dysfunction. Investigators asked patients to cough when detrusor contraction occurred following cessation of urinary flow. No simultaneous change of detrusor pressure (P det) could confirm that P det increase could be regarded as true DAC. Patients were subcategorized according to the presence of large postvoid urine volume, increase of electromyographic activity, the amount of P det change, and multiplicity. Results Detrusor contraction occurred after cessation of urinary flow in 245 patients (10.6%). The contractions of 57 patients (23.3%) were regarded as artifacts. DAC was identified in 188 patients (132 males, 5.7% and 56 females, 2.4%). The mean increase in P det from the initiation of DAC to the maximal P det of DAC was 22.6 ± 11.2 cmH 2O in males, and 18.6 ± 7.9 cmH 2O in females. DAC occurred more frequently as males became older. Detrusor pressures at maximal flow were higher in patients with DAC. Patients of both genders with bladder outlet obstruction (BOO) had an increased risk of developing DAC. Males with benign prostatic hyperplasia had an increased risk of developing DAC. Conclusions DAC should be differentiated from artifacts using cough test and the presence of DAC was significantly correlated to the presence of BOO. Copyright © 2011 Wiley-Liss, Inc.