Current concepts of the acontractile bladder

Abstract

The acontractile bladder (AcB) is a urodynamic-based diagnosis wherein the bladder is unable to demonstrate any contraction during a pressure flow study. Although it is often grouped with underactive bladder, it is a unique phenomenon and should be investigated independently. The purpose of the present review was to examine the current literature on AcB regarding its pathology, diagnosis, current management guidelines, and future developments. We performed a review of the PubMed database, classifying the evidence for AcB pathology, diagnosis, treatment, and potential future treatments. Over the 67 years covered in our review period, 42 studies were identified that met our criteria. Studies were largely poor quality and mainly consisted of retrospective review or animal models. The underlying pathology of AcB is variable with both neurological and myogenic aetiologies. Treatment is largely tailored for renal preservation and reduction of infection. Although future developments may allow more functional restorative treatments, current treatments mainly focus on bladder drainage. AcB is a unique and understudied bladder phenomenon. Treatment is largely based on symptoms and presentation. While cellular therapy and neuromodulation may hold promise, further research is needed into the underlying neuro-urological pathophysiology of this disease so that we may better develop future treatments.

Acontractile detrusor as an initial presentation of sacral spinal cord lesion: Case series

“…Acontractile bladder is a mysterious condition that represents a big challenge in terms of diagnosis and treatment. 1 Neurogenic acontractile detrusor can happen as a sequel of neurological insult at the level of the sacral spine or peripherally. 3 However, in this series, we describe that atonic bladder may be the first sign of neurological insult prior to the full clinical picture.…”

“…The literature consists of a low volume of evidence related to a such conditions which is mostly retrospective reviews or animal models. 1 The etiology of acontractile bladder includes neurological causes, myogenic failure, and dysfunctional voiding. Nevertheless, the initial step of management in such conditions is securing bladder emptying mainly by teaching patients Intermittent self-catheterization (ISC).…”

Therapeutic Efficacy of Human Embryonic Stem Cell-Derived Multipotent Stem/Stromal Cells in Diabetic Detrusor Underactivity: A Preclinical Study

“…Acontractile bladder is defined as occurring when “the detrusor cannot contract during urodynamic studies resulting in prolonged bladder emptying within a normal time span,” and is generally grouped with DUA under the clinical diagnosis of UAB [ 57 ]. Awake cystometry on long-term follow-up of DM animals (2 and 4 weeks following transplantation) revealed severely decreased contractility of the detrusor, which resembled detrusor acontractility or detrusor areflexia.…”