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Aims: The aims of this study were to determine how we can differentiate detrusor after-contraction (DAC) from artifacts, and to understand the clinical implications and significance of DAC., Materials and Methods: A retrospective analysis was performed on 2,309 patients with neurogenic or non-neurogenic voiding dysfunction. Investigators asked patients to cough when detrusor contraction occurred following cessation of urinary flow. No simultaneous change of detrusor pressure (P(det) ) could confirm that P(det) increase could be regarded as true DAC. Patients were subcategorized according to the presence of large postvoid urine volume, increase of electromyographic activity, the amount of P(det) change, and multiplicity., Results: Detrusor contraction occurred after cessation of urinary flow in 245 patients (10.6%). The contractions of 57 patients (23.3%) were regarded as artifacts. DAC was identified in 188 patients (132 males, 5.7% and 56 females, 2.4%). The mean increase in P(det) from the initiation of DAC to the maximal P(det) of DAC was 22.6 ± 11.2 cmH(2) O in males, and 18.6 ± 7.9 cmH(2) O in females. DAC occurred more frequently as males became older. Detrusor pressures at maximal flow were higher in patients with DAC. Patients of both genders with bladder outlet obstruction (BOO) had an increased risk of developing DAC. Males with benign prostatic hyperplasia had an increased risk of developing DAC., Conclusions: DAC should be differentiated from artifacts using cough test and the presence of DAC was significantly correlated to the presence of BOO., (Copyright © 2011 Wiley-Liss, Inc.)

The goal of this study was to evaluate the clinical and urodynamic features in Korean men with lower urinary tract symptoms (LUTS) and to determine non-invasive parameters for predicting bladder outlet obstruction (BOO). Four hundred twenty nine Korean men with LUTS over 50 yr of age underwent clinical evaluations for LUTS including urodynamic study. The patients were divided into two groups according to the presence of BOO. These two groups were compared with regard to age, the results of the uroflowmetry, serum prostate-specific antigen (PSA) level, prostate volume, International Prostate Symptom Score (I-PSS), and the results of the urodynamic study. Patients with BOO had a lower maximal flow rate (Q(max)), lower voided volume, higher serum PSA level and larger prostate volume (P<0.05). BOO group had a significantly higher rate of involuntary detrusor contraction and poor compliance compared to the patients without BOO (P<0.05). The multivariate analysis showed that Q(max) and poor compliance were significant factors for predicting BOO. Our results show that Q(max) plays a significant role in predicting BOO in Korean men with LUTS. In addition, BOO is significantly associated with detrusor dysfunction, therefore, secondary bladder dysfunction must be emphasized in the management of male patients with LUTS.