Ann Rehabil Med.  2014 Jun;38(3):342-346. 10.5535/arm.2014.38.3.342.

Phasic Changes in Bladder Compliance During Filling Cystometry of the Neurogenic Bladder

• Kim SY
• Ko SH
• Shin MJ
• Park YJ
• Park JS
• Lee KE
• Ko HY

• KMID: 2165751
• DOI: http://doi.org/10.5535/arm.2014.38.3.342

Abstract

OBJECTIVE
To investigate phasic changes during filling cystometry that most accurately represent detrusor properties, regardless of other factors affecting detrusor contractility.
METHODS
Seventy-eight patients (59 males, 19 females; mean age, 48.2 years) with spinal cord injuries were enrolled. Urodynamic studies were performed using a normal saline filling rate of 24 mL/min. We calculated bladder compliance values of the detrusor muscle in each of three filling phase intervals, which divided the filling cystometrogram into three phases referable to the cystometric capacity or maximum cystometric capacity. The three phases were sequentially delineated by reference to the pressure-volume curve reflecting bladder filling.
RESULTS
Bladder compliance during the first and second phases of filling cystometry was significantly correlated with overall bladder compliance in overactive detrusors. The highest coefficient of determination (r2=0.329) was obtained during the first phase of the pressure-volume curve. Bladder compliance during all three phases was significantly correlated with overall bladder compliance of filling cystometry in underactive detrusors. However, the coefficient of determination was greatest (r2=0.529) during the first phase of filling cystometry.
CONCLUSION
Phasic bladder compliance during the early filling phase (first filling phase) was the most representative assessment of overall bladder compliance during filling cystometry. Careful determination of early phase filling is important when seeking to acquire reliable urodynamic data on neurogenic bladders.

Keyword

Urodynamics; Compliance; Spinal cord injuries

MeSH Terms

Compliance*
Female
Humans
Male
Spinal Cord Injuries
Urinary Bladder*
Urinary Bladder, Neurogenic*
Urinary Bladder, Overactive
Urodynamics

Figure

• 

  Fig. 1 Three phases of the filling cystometry. The bladder pressure-capacity curve was divided into three phases according to the points of filling, such as 1/3 (phase I), 2/3 (phase II), and 3/3 (phase III) of cystometric bladder capacity.

Reference

1. Wyndaele JJ, Gammie A, Bruschini H, De Wachter S, Fry CH, Jabr RI, et al. Bladder compliance what does it represent: can we measure it, and is it clinically relevant? Neurourol Urodyn. 2011; 30:714–722. PMID: 21661019.

2. Landau EH, Jayanthi VR, Churchill BM, Shapiro E, Gilmour RF, Khoury AE, et al. Loss of elasticity in dysfunctional bladders: urodynamic and histochemical correlation. J Urol. 1994; 152(2 Pt 2):702–705. PMID: 8021999.

3. Abrams P. Urodynamics. 3rd ed. London: Springer;2006.

4. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002; 21:167–178. PMID: 11857671.

5. Csapo AI. Smooth muscle as a contractile unit. Physiol Rev Suppl. 1962; 5:7–33. PMID: 13882505.

6. Edvardsen P. Nervous control of urinary bladder in cats. I. The collecting phase. Acta Physiol Scand. 1968; 72:157–171. PMID: 5655748.

7. Marsh DJ, Suzuki G, Meyers FH. Role of afferent activity from the bladder in regulating its activity. Am J Physiol. 1959; 196:351–353. PMID: 13627178.

8. van Koeveringe GA, Vahabi B, Andersson KE, Kirschner-Herrmans R, Oelke M. Detrusor underactivity: a plea for new approaches to a common bladder dysfunction. Neurourol Urodyn. 2011; 30:723–728. PMID: 21661020.

9. Kaplan SA, Chancellor MB, Blaivas JG. Bladder and sphincter behavior in patients with spinal cord lesions. J Urol. 1991; 146:113–117. PMID: 2056568.