Bladder Emptying: Contractility

  • Chasta Bacsu
  • Jack C. Hou
  • Gary E. LemackEmail author


Bladder contractility is a measure of detrusor muscle contractile strength and it can be affected by a variety of factors. In this chapter, conditions such as detrusor underactivity, acontractile detrusor, detrusor hyperactivity and impaired contractility, and other abnormal forms of detrusor function will be discussed extensively with urodynamics tracings demonstrating each clinical scenario. Other factors that can affect bladder contractility, such as the bladder outlet, will also be reviewed in this chapter underscoring the importance of understanding the relationship between bladder contractility and outlet resistance. A properly performed urodynamic study is a powerful tool in better understanding disorders of bladder contractility.


Detrusor Overactivity Bladder Outlet Obstruction Detrusor Contraction Detrusor Pressure Valsalva Leak Point Pressure 
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  1. 1.
    Sullivan M, Yalla S. Functional studies to assess bladder contractility. J Urol Urogynakol. 2007;14(1):7–10.CrossRefGoogle Scholar
  2. 2.
    Tan T, et al. Stop test or pressure-flow study? Measuring detrusor contractility in older females. Neurourol Urodyn. 2004;23:184–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Abrams P. Bladder outlet obstruction index, bladder contractility index, and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int. 1999;84:14–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Gerstenberg TC, et al. High flow infravesical obstruction in men: symptomatology, urodynamics and the results of surgery. J Urol. 1982;127(5):943–5.PubMedGoogle Scholar
  5. 5.
    Griffiths C, Rix D, Macdonald A. Noninvasive measurement of bladder pressure by controlled inflation of a penile cuff. J Urol. 2002;167:1344–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Griffiths D. Detrusor contractility: order out of chaos. Scand J Urol Nephrol Suppl. 2004;215:93–100.PubMedCrossRefGoogle Scholar
  7. 7.
    Griffiths D, Constantinou C, Van Mastriqt R. Urinary bladder function and its control in healthy females. Am J Physiol. 1986;251:R225–30.PubMedGoogle Scholar
  8. 8.
    Sekido N. Bladder contractility and urethral resistance relation: what does a pressure-flow study tell us? Int J Urol. 2012;19:216–28.PubMedCrossRefGoogle Scholar
  9. 9.
    Seki N, et al. Voiding dynamics in women with stress urinary incontinence and high-stage cystocele. Int J Urol. 2011;18(3):219–24.PubMedCrossRefGoogle Scholar
  10. 10.
    Cucchi A, et al. Urodynamic findings suggesting two-stage development of idiopathic detrusor underactivity in adult men. Urology. 2007;70:75–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Cucchi A, Quaglini S, Rovereto B. Development of idiopathic detrusor underactivity in women: from isolated decrease in contraction velocity to obvious impairment of voiding function. Urology. 2008;71:844–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Schafer W. Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple. World J Urol. 1995;13:47–58.PubMedCrossRefGoogle Scholar
  13. 13.
    Haylen B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4–20.PubMedGoogle Scholar
  14. 14.
    Maderbacher S, et al. The aging lower urinary tract: a comparative urodynamic study of men and women. Urology. 1998;51:206–12.CrossRefGoogle Scholar
  15. 15.
    Gomes C, Arap S, Trigo-Rocha F. Voiding dysfunction and urodynamic abnormalities in elderly patients. Rev Hosp Clin Fac Med Sao Paulo. 2004;59:206–15.PubMedCrossRefGoogle Scholar
  16. 16.
    Nordling J. The aging bladder: a significant but underestimated role in the development of lower urinary tract symptoms. Exp Gerontol. 2002;37:991–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Ababanel J, Marcus E-L. Impaired detrusor contractility in community-dwelling elderly presenting with lower urinary tract symptoms. Urology. 2007;69:436–40.CrossRefGoogle Scholar
  18. 18.
    Prieto C, Sanchez D, Salinas C. Effect of aging on detrusor function in males. Arch Esp Urol. 1997;50:579–83.Google Scholar
  19. 19.
    Taylor J, Kuchel G. Detrusor underactivity: clinical features and pathogenesis of an underdiagnosed geriatric condition. J Am Geriatr Soc. 2006;54:1920–32.PubMedCrossRefGoogle Scholar
  20. 20.
    Elbadawi A, Yalla S, Resnick N. Structural basis of geriatric voiding dysfucntion. II. Aging detrusor normal versus impaired contractility. J Urol. 1993;150:1657–67.PubMedGoogle Scholar
  21. 21.
    Griffiths D, et al. Cerebral control of the lower urinary tract: how age-related changes might predispose to urge incontinence. Neuroimage. 2009;47:981–6.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Anderssen K-E. Detrusor underactivity/underactive bladder: new research initiatives needed. J Urol. 2010;184:1829–30.CrossRefGoogle Scholar
  23. 23.
    Krishnamoorthy S, Kekre N. Detrusor underactivity: to tone or not to tone the bladder? Indian J Urol. 2009;25:407–8.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Barendrecht M, et al. Is the use of parasympathomimetics for treating underactive urinary bladder evidence-based? BJU Int. 2007;99:749–52.PubMedCrossRefGoogle Scholar
  25. 25.
    Ou R, et al. Urodynamically diagnosed detrusor hypocontractility: should transurethral resection of the prostate be contraindicated. Int Urol Nephrol. 2012;44:35–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Han D, et al. The efficacy of transurethral resection of the prostate in patients with weak bladder contractility index. Urology. 2008;71:657–61.PubMedCrossRefGoogle Scholar
  27. 27.
    Ginsberg D. Bladder acontractility: detrusor myoplasty and other options. Nat Rev Urol. 2011;8:185–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Lombardi G, et al. Clinical efficacy of intravesical electrostimulation on incomplete spinal cord patients suffering from chronic neurogenic non-obstructive retention: a 15 year single centre retrospective study. Spinal Cord. 2013;51:232–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Resnick N, Yalla S. Detrusor hyperactivity with impaired contractile function. JAMA. 1987;257:2076–3081.CrossRefGoogle Scholar
  30. 30.
    Yalla S, Sullivan M, Resnick N. Update on detrusor hyperactivity with impaired contractility. Curr Bladder Dysfunct Rep. 2007;2:191–6.CrossRefGoogle Scholar
  31. 31.
    Lui S, Chan L, Tse V. Clinical outcome in patients with detrusor hyperactivity with impaired contractility (DHIC). BJU Int. 2011;107(supp):7.Google Scholar
  32. 32.
    Miller E, et al. Preoperative urodynamic function may predict voiding dysfunction in women undergoing pubovaginal sling. J Urol. 2003;169:2234–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Bhatia N, Bergeman A. Urodynamic predictability of voiding following incontinence surgery. Obstet Gynecol. 1984;63:85–91.PubMedGoogle Scholar
  34. 34.
    Pham K, et al. Preoperative Valsalva voiding increases the risk of urinary retention after midurethral sling placement. Int Urogynecol J. 2010;21:1243.PubMedCrossRefGoogle Scholar
  35. 35.
    Chao R, Mayo M. Incontinence after radical prostatectomy: detrusor or sphincter causes. J Urol. 1995;154:16–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Han J, et al. Treatment of post-prostatectomy incontinence with male slings in patient with impaired detrusor contractility on urodynamics and/or who perform valsalva voiding. J Urol. 2011;185:1370–5.CrossRefGoogle Scholar
  37. 37.
    Gomha M, Boone T. Voiding patterns in patients with post-prostatectomy incontinence: urodynamic and demographic analysis. J Urol. 2003;169:1766–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Miller E. Physiology of the lower urinary tract. Urol Clin North Am. 1996;23:171–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Groutz A, et al. Learned voiding dysfunction (Non-neurogenic, neurogenic bladder) among adults. Neurourol Urodyn. 2001;20:259–68.PubMedCrossRefGoogle Scholar
  40. 40.
    Carlson K, Rome S, Nitti V. Dysfunctional voiding in women. J Urol. 2001;165:143–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Bower W, et al. Assessment of non-neurogenic incontinence and lower urinary tract symptoms in adolescents and young adults. Neurourol Urodyn. 2010;29:702–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Wang Y-C, Hart D, Mioduski J. Characteristics of patients seeking outpatient rehabilitation for pelvic-dysfunction. Phys Ther. 2012;92:1160–74.PubMedCrossRefGoogle Scholar
  43. 43.
    Rosier P, et al. Developing evidence-based standards for diagnosis and management of lower urinary tract or pelvic floor dysfunction. Neurourol Urodyn. 2012;31:621–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Abrams P, et al. The standardisation of terminology in the lower urinary tract: report from the Standardisation Sub-Committee of the International Continence Society. Urology. 2003;61(1):37–49.PubMedCrossRefGoogle Scholar
  45. 45.
    Groutz A, Blavais J. Non-neurogenic female voiding dysfunction. Curr Opin Urol. 2002;12:311–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Adelowo A, et al. Do symptoms of voiding dysfunction predict urinary retention? Female Pelvic Med Reconstr Surg. 2012;18:344–7.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    DasGupta R, Fowler C. The management of female voiding dysfunction: Fowler’s syndrome—a contemporary update. Curr Opin Urol. 2003;13:293–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Kavia R, et al. Urinary retention in women: its causes and management. BJU Int. 2006;97:281–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Yande S, Joshi M. Bladder outlet obstruction in women. J Midlife Health. 2011;2:11–7.PubMedCentralPubMedGoogle Scholar
  50. 50.
    De Ridder D, Ost D, Bruyninckx F. The presence of Fowler’s syndrome predicts successful long-term outcome of sacral nerve stimulation in women with urinary retention. Eur Urol. 2007;51:229–34.PubMedCrossRefGoogle Scholar
  51. 51.
    Fowler C, et al. Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome? BMJ. 1988;297:1436–8.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of UrologyUT Southwestern Medical CenterDallasUSA

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