title: [Changes in detrusor contractility in bladder hyperreflexia].
abstract: OBJECTIVE
  Classically, it was understood detrusor contractility was affected in bladder areflexia but not in hyperreflexia. We aim to demonstrate that there is some detrusor contractility affectation in bladder hyperreflexias, although it may seem paradoxical at first sight.
  
  
  METHODS
  Neuro-urologic study was performed in a series of 68 consecutive patients with bladder hyperreflexia (neurogenic detrusor hyperactivity), referred to the unit of functional urology for urodynamic evaluation. All patients underwent clinical history, post void residual determination, cystomanometry, voiding pressure-flow test, videourodynamics and selective EMG of the periurethral sphincter. Detrusor contractile potency was measured with W 80-20. Terminology follows the ICS standard. Data processing was performed using the statistical software SPSS 12.0.
  
  
  RESULTS
  This series includes 14 males (58.8%) and 28 females (41.2%), of all ages (adults more frequent). 88.2% of the cases had acquired neurological diseases (trauma 30.9%; medical 33.8%; degenerative 35.3%), and 11.8% congenital neurological diseases (myelodysplasia). Most frequent type of neurological lesion was detrusor-sphincter dyssynergia: 59 cases (79.4%); 22 patients (32.4%) had undergone previous treatment of their vesicourethral dysfunction. The amplitude of detrusor involuntary contractions was wider in detrusor-bladder neck dyssynergia. Detrusor isotonic contractility (W 80-20) was significantly affected, mainly in neurological lesions of traumatic nature and less in degenerative lesions (p = 0.01).
  
  
  CONCLUSIONS
  We demonstrated that bladder contractility is affected in bladder hyperreflexias (neurogenic detrusor hyperactivity), more important in traumatic lesions without relationship with the type of neurological associated lesion, which could be related to a bladder structural change, or with a change in the central neurological tracts (without requirement of presence of dyssynergia).
authors: Servicio Urología, Hospital Clínico San Carlos, Universidad Complutense, Madrid, España. jsalinascasado@yahoo.es
authors: Jesús
authors: J
authors: Salinas
authors: Humberto
authors: H
authors: Pelaquin
authors: Sara
authors: S
authors: Prieto
authors: Miriam
authors: M
authors: Dambros
authors: Isabel
authors: I
authors: Viudez
authors: Miguel
authors: M
authors: Virseda
authors: Angel
authors: A
authors: Silmi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D009130:Muscle, Smooth / Q000503:physiopathology; D012021:Reflex, Abnormal; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology*; D014563:Urodynamics