title: Urodynamic after-contraction waves: a large observational study in an adult female population and correlation with bladder and ureter emptying functions in women.
abstract: OBJECTIVE
  To evaluate different patterns of after-contraction (A-C) waves detected during urodynamic evaluation in women.
  
  
  METHODS
  4,110 women were prospectively observed regarding the presence of A-C waves upon urodynamic evaluation. Intravenous pyelography and ultrasound were requested. Paired t test, χ(2) test, Wilcoxon's rank sum test and correlation analysis were performed with a 95% significance level.
  
  
  RESULTS
  There were three distinguishing patterns of A-C: type I - detrusor contraction after the regular voiding phase, type II - detrusor contraction persisting after the flow rate had stopped, and type III - rebound of the detrusor contraction after the flow. A-C was observed in 13.9% of the women. Type I A-C wave patterns were present in 68 patients (11.8%), type II A-C wave patterns in 477 patients (83.2%), and type III A-C wave patterns in 28 patients (10.3%). Studies with intravenous pyelography and ultrasound very frequently showed bladder mucosa, muscle thickening or trabeculation. Secondary ureterectasis related to A-C waves was also observed. Additionally, watts factor, maximum flow rate, detrusor pressure and opening detrusor pressure were markedly elevated in patients with type III A-C, suggesting enhanced detrusor contraction in these A-C waves.
  
  
  CONCLUSIONS
  A-C waves are a real urodynamic entity with different patterns of presentation and with clinical and morphological alterations.
authors: Urology Clinic, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
authors: Paulo
authors: P
authors: Rodrigues
authors: Flávio
authors: F
authors: Hering
authors: João Carlos
authors: JC
authors: Campagnari
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction; D009130:Muscle, Smooth / Q000000981:diagnostic imaging / Q000502:physiology*; D011312:Pressure; D011446:Prospective Studies; D011859:Radiography; D012737:Sex Factors; D014463:Ultrasonography; D014513:Ureter / Q000000981:diagnostic imaging / Q000502:physiology*; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000502:physiology*; D014546:Urinary Catheterization; D014563:Urodynamics