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Biomechanics of the urinary bladder: spontaneous contraction activity and micromotions related to accommodation

  • Urology - Original Paper
  • Published:
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Abstract

Purpose

Knowledge of the fundamental properties of the urinary bladder is required to better understand its pathological conditions. Research on the passive and active properties of the bladder during stretching and contraction is important. The bladder is not passive during the filling phase. Spontaneous contractions are observed as variations in pressure, which are mostly related to urgency and/or incontinence and sometimes to pelvic pain. The purpose of this study was to describe distributed spontaneous contractions and micromotions (MMs), which besides being related to symptoms, are crucial in the physiological process of accommodation, and to express accommodation in a concept.

Method

After describing MMs in the bladder wall as the type of spontaneous activity that may not be reflected in detrusor pressure and as a source of afferent nerve activity, its biomechanical effects are considered. In a simple mechanical model, contractions and elongations are related to the plastic elongated state of the bladder. The changing distributed character of contractions and elongations in the bladder wall is represented in a modular scheme.

Results

Distributed transient contractions and MMs yield a balanced dynamic plastic state of the regions of the bladder wall. An almost constant detrusor pressure can be attributed to the active accommodation of detrusor pressure to changes in bladder volume.

Conclusion

Localized contractile activity and MMs that change the plastic elongated state of varying bladder regions are biomechanically effective in the active accommodation of detrusor pressure to changes in bladder volume. According to this concept, autonomous bladder wall activity as a source of nerve activity, also is crucial for active accommodation.

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Author information

Author notes

  1. W. A. van Duyl

    Present address: , Krimpen aan den IJssel, The Netherlands

Authors and Affiliations

  1. Noordheuvel 50, 2990, Wuustwezel, Belgium

    B. L. R. A. Coolsaet

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  1. W. A. van Duyl
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Contributions

In the past WAvD (ORCID: 0000-0003-4801-0091) and BC (ORCID: 0000-0003-3100-1244) worked and published together on bladder mechanics. Both authors are retired now. WAvD as a biophysicist introduced the concept on micromotion in 1985 while initially BC as a urologist was involved in clinical evaluation of this concept. Both authors have made substantial contributions to all of the following: 1-the conception and design of the study, or acquisition of data, or analysis and interpretation of data, 2- drafting the article or revising it critically for important intellectual content, 3- final approval of the version to be submitted. The manuscript has not been previously published and is not under consideration elsewhere. All material including figures are free from copyrights..

Corresponding author

Correspondence to W. A. van Duyl.

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Conflict of interest

We certify that the information provided on suggested reviewers is accurate and that there are no conflicts of interest between the authors and these individuals.

Ethical approval

Micromotions have been observed in many animal studies and nowadays are considered as a basic urological phenomenon. In a study of micromotions in human it has been shown that micromotions are related to bladder sensation and urge. This conclusion has been referred to by many authors. The need for models of how spontaneous contractions influence pressure generation is formulated at a ICRS meeting in 2018.

Informed consent

In present article we derive from previously published observations a new physiological meaning of micromotions in relation to the accommodation of bladder pressure to bladder volume and to bladder shape by considering accommodation as an active process. This active component in accommodation has consequences for clinical evaluation of spontaneous contraction activity. The subject is relevant for clinical urodynamics.

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W. A. van Duyl: Formerly at Erasmus University Rotterdam, Department of Medical Physics and Technology and Delft Technical University, Department of Electronic Instrumentation, The Netherlands.

B. L. R. A. Coolsaet: Formerly at State University Utrecht, Department of Urology, The Netherlands.

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van Duyl, W.A., Coolsaet, B.L.R.A. Biomechanics of the urinary bladder: spontaneous contraction activity and micromotions related to accommodation. Int Urol Nephrol 53, 1345–1353 (2021). https://doi.org/10.1007/s11255-021-02814-w

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