<title>ABSTRACT</title><sec><title>Aims:</title><p>Detrusor after-contractions (DAC) are non-common in adults. Both definition (nothing in ICS reports) and significance (artefact, link with detrusor overactivity (DO) or bladder outlet obstruction (BOO)) remain discussed. Our purpose was to carry out an analysis of the urodynamic parameters during voidings with DAC and, using the VBN model, to simulate pathophysiological conditions able to explain both voiding phase and DAC.</p></sec><sec><title>Materials and Methods:</title><p>From large urodynamic database of patients referred for evaluation of lower urinary tract dysfunction, DAC were observed in 60 patients (5.7%). Criteria for DAC were post-void residual <30mL and increase of detrusor pressure >10cmH₂O. VBN model was used for analysis of both pressure and flow curves, and simulations of pathophysiological conditions.</p></sec><sec><title>Results:</title><p>Onset of DAC (ODAC) occurred when Q=7.3±5.7mL/s and bladder volume=17.9±15.4mL. Urgency-frequency syndrome and urodynamic diagnosis of DO were the more frequent scenarios associated with DAC. ODAC was associated to an inversion of the slope of detrusor pressure curve without any perturbation in flow curve. Among tested pathophysiological hypothesis (great, abnormal, detrusor force, sphincter contraction), none allowed restoring all recorded curves (flow rate, voiding pressure and DAC).</p></sec><sec><title>Conclusion:</title><p>No urodynamic characteristic of the first part of voiding is an index of occurrence of DAC. ODAC is a significant phenomenon linked with the bladder collapse. DAC is not associated with BOO but more probably with DO and appears as the result of local conditions in an almost empty bladder (concentration of stresses around a transducer); thus DAC seems of weak clinical significance.</p></sec>

OBJECTIVES: To search for relationships between phasic (P) and terminal (T) DO with age, urodynamic findings and sphincter behavior during involuntary detrusor contraction in woman. MATERIALS AND METHODS: Urodynamic studies (triple lumen catheter 7F, seated position) of 164 successive women referred for LUTS with diagnosis of DO were reviewed. Patients were stratified in 4 sub-groups: pre- (18-44y), peri- (45-54 y), post-menopause (55-74 y) and oldest old (≥ 75 y). The urethral sensor was positioned at the level of the maximum urethral closure pressure for sphincter behavior analysis. A variation of at least 5 cmH2O in pressure (detrusor or urethra) was chosen to assert DO or sphincter response. Sphincter response was classified as relaxation (re) before or during DO, or steady (st). RESULTS: Occurrence of P and TDO was similar: 77 P and 87 T. The PDO group was significantly younger (p = 0.0003). TDO was more frequent in patients with a history of neurological disease. The percentage of PDO remained almost constant in age groups, while that of TDO increased with age from 6.7% to 23.2% (p = 0.0013). Uninhibited contraction occurred at a smaller bladder volume in the P group: 149 ± 95 vs. 221 ± 113 mL (p < 0.0001). Steady sphincter predominated in the TDO subgroup: 45.9% vs. 32.1% and increased significantly in each DO sub-group of ³ 75y. CONCLUSION: Steady sphincter during both P and TDO, and occurrence of TDO appear as specific of aging. The last result could be related to structural changes in the detrusor muscle with aging.

PURPOSE: To determine why community-dwelling women aged 80 years or over were referred for urodynamic evaluation despite their advanced age and which urodynamic diagnosis was made. MATERIALS AND METHODS: One hundred consecutive females (80-93 years) were referred to our urodynamics outpatient clinic for evaluation of lower urinary tract symptoms (LUTS) between 2005 and 2008. Clinical evaluation comprised of a previous history of LUTS, previous medical history of neurological disease or dementia, pelvic floor dysfunction or prior pelvic surgery. Exclusion criteria were complete retention and severe dementia involving failure to understand simple instructions. Assessed items were results of uroflows (free flow and intubated flow), cystometry and urethral pressure profilometry, and final urodynamic diagnosis. RESULTS: The main complaint evoked by the patients was incontinence (65.0%) of which 61.5% was "complicated" and urgency was reported by 70.0%. Interpretable free flow at arrival was very low (44.0%). Prevalence of detrusor overactivity was high, found in 45 patients of whom 16 had detrusor hyperactivity with impaired detrusor contractility. Detrusor overactivity and urgency were strongly associated (p = 0.004). Twenty-five patients had intrinsic sphincteric deficiency alone and 15 detrusor underactivity. CONCLUSION: In this particular community-dwelling with an elderly female population, urodynamics is easily feasible. Incontinence, mainly "complicated" is the more frequent complaint and urgency the more frequent symptom. Urodynamic diagnosis underlines the high incidence of detrusor overactivity as well as impaired detrusor function.

Purpose: Rhythmic or random rectal contractions independent of bladder activity are frequently observed during cystometry and usually attributed either to a neurological disease, or to ageing. The aim of our study was to search for an association of rhythmic rectal contractions (RRCs) with a specific lower urinary tract symptom or/and an urodynamic diagnosis. Materials and Methods: The population consisted of 534 consecutive women with lower urinary tract symptoms and without specific gastro-intestinal disease referred for urodynamics; 382 (non-ND) had no history of neurological disease and 152 (ND) a history of neurological disease. Cystometries were performed according to ICS recommendations. Rectal pressure was measured using a punctured balloon filled with 2 mL of saline. RRCs were defined as rhythmic changes in the rectal pressure of at least 3 cm H2O independent of the total vesical pressure. Results: RRCs were observed in 69 patients, with no difference in neurological status or age (non-ND: 12.3% and 65.5y; ND: 14.5% and 62.7y). Patients with RRCs were significantly older than the negative population (p = 0.0002). RRCs had a low frequency: 1 - 4/min; their amplitude was ≤ 15 cm H2O in 67 patients. RRCs were associated with urgency (35 patients) whatever the neurological status and with detrusor overactivity only in the neurological patients. Conclusions: RRCs cannot be considered as artefactual events during cystometry in women, occur in the older population, are frequently associated with urgency but not with detrusor overactivity or neurological disease. Occurrence of RRCs should prompt the physician to look at the possible causes of urgency (colonic or bladder).