Urodynamic patterns of normal male micturition: influence of water consumption on urine production and detrusor function.
OBJECTIVE
Urodynamic characterization of normal male micturition can be a useful standard in the analysis of data on patients complaining of voiding dysfunction. The validity of such a standard is based on the need to obtain baseline parameters of pressure flow values, an important consideration when evaluating prostatic obstruction and its treatment. While current numerical pressure flow values provide a useful summary of the voiding sequence, a more complete analysis of the pattern of normal voiding may reveal more functionally useful information concerning micturition. We establish basic experimental conditions that simulate normal voiding of physiologically produced urine by the kidneys measured at intervals representing real stages of bladder filling. We report the results of an investigation designed to study consecutive micturitions at bladder volumes determined by water consumption and endogenous circadian rhythm. Our particular focus is to examine critically the urodynamic pattern of pressure flow and obtain evidence to support the hypothesis that fluid consumption has an important role in detrusor function.


METHODS
Urodynamic studies were conducted on 39 asymptomatic male volunteers with a mean age of 25.8 years (range 21 to 31) and mean weight of 75.5 kg. (range 63 to 95). Volunteers were divided into 2 groups according to water consumption regimen of 30 ml./kg. daily (17 patients, group 1) and 60 ml./kg. daily (12, group 2). Bladder pressure was monitored via a suprapubic catheter and abdominal pressure was measured via a rectal balloon using an ambulatory system. Average duration of each monitoring period was 20.5 hours. Detrusor pressure and flow rate records from each subject were identified, and consecutive filling and voiding phases were averaged during the entire monitoring period using the onset of micturition as a time marker. The average pattern of pressure, flow rate, cumulative volume and contractility curves for each subject, as well each for group, was computed and graphically presented. For each group the average parameters of urethral opening pressure, maximum detrusor pressure, detrusor pressure at maximum flow rate, bladder capacity and bladder contraction strength were calculated and compared statistically. Numerical values are mean +/- SE.


RESULTS
Water consumption and urine production rate influenced the pattern and many of the urodynamic parameters of micturition. In both groups there was a detrusor pressure increase before voiding and numerically maximum detrusor pressure consistently occurred before micturition started. Micturition pattern showed an asymptotic relationship between pressure and flow. Doubling of water consumption increased urethral opening pressure from 51.2 +/- 3.2 to 61.5 +/- 5.1 (p <0.05), maximum detrusor pressure from 58.9 +/- 4.5 to 70.0 +/- 6.2 cm. H(2)O (p <0.01) and contractility from 15.4 +/- 1.4 to 17.7 +/- 1.4 w/m(2). There were no significant differences due to water consumption in maximum flow rate (24.4 +/- 1.4 to 25.2 +/- 1.8 ml. per second) or bladder capacity (286 +/- 20 to 329 +/- 15 ml.) but a significant increase in the number of micturitions from 5.8 +/- 0.5 to 9.8 +/- 0.5 per day (p <0.001) proportional to water consumption.


CONCLUSIONS
The configuration of the observed pressure flow characteristics of the normal male is suggestive of the "Starlings law" relationship and the pattern of the urodynamic parameters were markedly different from those reported in the current standardization literature, suggesting the need to revise the current concept of normal male micturition. Voiding pressure and contractility increased in accordance with water consumption and urine production.
D000328:Adult; D004326:Drinking / Q000502:physiology*; D006801:Humans; D006874:Hydrostatic Pressure; D008297:Male; D012016:Reference Values; D014521:Urethra / Q000502:physiology*; D001743:Urinary Bladder / Q000502:physiology*; D014554:Urination / Q000502:physiology*; D014563:Urodynamics / Q000502:physiology*