Various in vitro and in vivo animal studies have shown that adenosine triphosphate (ATP) has a stimulatory role and nitric oxide (NO) has an inhibitory role in modulating bladder contractility. However, it is not known what happens to the urinary levels of ATP and NO in humans with underactive bladder (UAB).
In this prospective case–control study, we compared ATP and NO levels in twenty six male patients of UAB with a bladder contractility index (BCI) of < 100 and 18 healthy male volunteers without any lower urinary tract symptoms (LUTS).
The mean urinary ATP levels were significantly lower in cases compared to controls (546.1 ± 37.3 pg/µl vs. 610.7 ± 24.9 pg/µl, p value < 0.001) and the mean NO levels were significantly higher in cases compared to controls (1233.4 ± 91.2 pg/µl vs. 1126.3 ± 91.3.4 pg/µl, p value < 0.001). The mean NO/ATP ratio in cases was significantly higher than that of controls (2.26 ± 0.2 vs. 1.84 ± 0.18, p value < 0.000). Using receiver operating curve (ROC) analysis, we noted the area under the curve (AUC) for NO/ATP ratio to be 0.91 in the diagnosis of cases. A cut-off value of 2.06 for NO/ATP ratio had sensitivity, specificity and diagnostic accuracy of 88.5%, 88.9% and 88.6%, respectively, in diagnosing patients with UAB.
Patients with UAB have significantly higher levels of urinary NO and decreased levels of urinary ATP. Urinary NO/ATP levels can be considered as a noninvasive alternate test for diagnosing bladder underactivity.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Data availability statement
The authors confirm that data supporting the findings of this study are available within the article/supplementary materials.
Osman NI, Chapple CR, Abrams P et al (2014) Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol 65:389–398
Birder LA (2006) Urinary bladder urothelium: molecular sensors of chemical/thermal/mechanical stimuli. Vascul Pharmacol 45:221–226
Munoz A, Smith CP, Boone TB et al (2011) Overactive and underactive bladder dysfunction is reflected by alterations in urothelial ATP and NO release. Neurochem Int 58:295–300
Jeong SJ, Kim HJ, Lee YJ et al (2012) Prevalence and clinical features of detrusor underactivity among elderly with lower urinary tract symptoms: a comparison between men and women. Korean J Urol 53:342–348
Kumar V, Chapple CC, Chess-Williams R (2004) Characteristics of adenosine triphosphate [corrected] release from porcine and human normal bladder. J Urol 172:744–747
Harvey RA, Skennerton DE, Newgreen D et al (2002) The contractile potency of adenosine triphosphate and ecto-adenosine triphosphatase activity in guinea pig detrusor and detrusor from patients with a stable, unstable or obstructed bladder. J Urol 168:1235–1239
Birder LA, Nakamura Y, Kiss S et al (2002) Altered urinary bladder function in mice lacking the vanilloid receptor TRPV1. Nat Neurosci 5:856–860
Pandita RK, Andersson KE (2002) Intravesical adenosine triphosphate stimulates the micturition reflex in awake, freely moving rats. J Urol 168:1230–1234
Smith CP, Gangitano DA, Munoz A et al (2008) Botulinum toxin type A normalizes alterations in urothelial ATP and NO release induced by chronic spinal cord injury. Neurochem Int 52:1068–1075
Ozawa H, Chancellor MB, Jung SY et al (1999) Effect of intravesical nitric oxide therapy on cyclophosphamide-induced cystitis. J Urol 162:2211–2216
Cho KJ, Koh JS, Choi J et al (2017) Changes in adenosine triphosphate and nitric oxide in the urothelium of patients with benign prostatic hyperplasia and detrusor underactivity. J Urol 198:1392–1396
Daneshgari F, Liu G, Imrey PB (2006) Time dependent changes in diabetic cystopathy in rats include compensated and decompensated bladder function. J Urol 176:380–386
None to declare.
Received before study initiation(INT/IEC/2017/1396).
Consent to participate and publication
Obtained from all the patients.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Krishnan, A., Sharma, G., Devana, S.K. et al. Urinary adenosine triphosphate and nitric oxide levels in patients with underactive bladder: a preliminary study. World J Urol (2021). https://doi.org/10.1007/s00345-021-03784-5
- Underactive bladder
- Adenosine triphosphate
- Nitric oxide