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Urinary adenosine triphosphate and nitric oxide levels in patients with underactive bladder: a preliminary study



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.

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Data availability statement

The authors confirm that data supporting the findings of this study are available within the article/supplementary materials.


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Author information




All authors have read and approved the final manuscript. AKG: protocol development, data collection and management, data analysis and manuscript writing. GS: data collection and management, data analysis and manuscript writing. SKD: data collection and management, data analysis, and manuscript writing. DZ: data collection and management, manuscript writing and editing. RSM: data collection and management, manuscript writing and editing. AKM: data collection and management, manuscript editing. APS: manuscript writing and editing. GSB: manuscript writing and editing.

Corresponding author

Correspondence to S. K. Devana.

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Received before study initiation(INT/IEC/2017/1396).

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Obtained from all the patients.

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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).

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  • Underactive bladder
  • Adenosine triphosphate
  • Nitric oxide
  • Biomarker