The Pathophysiology of Large Capacity Bladder
Authors:
R. S. Purohit; J. G. Blavais; K. L. Saleem; J. Sandu; J. P. Weiss; B. Reddy
Published in:
Urol List 2008; 6(1): 5-11
Overview
Purpose:
To describe the pathophysiolgy, differential diagnosis and urodynamic findings in patients with large bladder capacities (LCB).
Materials and Methods:
This is a retrospective observational study of 100 consecutive patients with voiding dysfunction and a cystometric bladder capacity of greater than 700 ml. Clinical data, cystometricbladder capacity and other urodynamic findings were evaluated. Bladder outlet obstruction (BOO) andimpaired detruzoru contractility (IDC) were defined by the Schafer nomogram in men and the Blaivas-Groutz nomogram in women.
Results:
56 men and 44 women, aged from 36 to 97 years (median 75, mean 71.2) with bladder capacitiesranging from 700 to 5013 ml (median 931, mean 1091 ml) were studied. The primary pathophysiologicdiagnoses included BOO (48 %), IDC (11 %), absent detrusor contractility (24 %), and normal detrusorpressure/uroflow study in 17 %. BOO was attributed to anatomic obstruction in 34 %, acquired voidingdysfunction in 11 %, and detrusor-external sphincter dyssynergia in 3 %. For patients demonstratingdetrusor contractions, the initial contraction occurred at a median of 1 000 ml (mean 1 154 ml, range86–5 000 ml). Associated diagnoses in men included benign prostatic enlargement (52 %), neurologic disease(14 %) and in women, pelvic organ prolapse (27 %), stress incontinence (18 %) and neurologic disorders(9 %). In both sexes, diabetes mellitus was only seen in (5 %) and large bladder diverticula in (15 %).
Conclusion:
The etiology of LCB is multifactorial and, in most cases there is a potentially remediable underlyingcondition. LCB may be accompanied by BOO, impaired or absent detrusor contractions or normal detrusorpressure/uroflow studies. When detrusor contractions are present, they usually occur only at large bladdervolumes; therefore, it is important during cystometry to fill the bladder until bladder capacity is reached.
Key Words:
large capacity bladder, pathophysiology, urodynamics
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