Neurourology and Urodynamics 24:202^206 (2005) Urgency of Micturition and Detrusor Contractility in Men With Prostatic Obstruction and Overactive Bladders A. Cucchi, 1 * S. Quaglini, 2 A. Giannantoni, 3 C. Guarnaschelli, 4 and B. Rovereto 1 1 Divisione di Urologia, Policlinico san Matteo, Pavia, Italy 2 Dipartimento di Informatica e Sistemistica, Universita' di Pavia, Italy 3 Clinica Urologica, Universita' di Perugia, Italy 4 Fondazione S. Maugeri, Istituto Scienti¢co di Montescano (Pavia) Italy Aims: In men with prostatic obstruction and detrusor overactivity (DO), to ascertain whether urgency of micturition a¡ects bladder contractility. Materials and Methods: We urodynamically assessed ¢ve groups of 20 men each who had bladder out£ow obstruction (BOO) from benign pro- static enlargementöGroups 1 (with no DO and no urgency), 2 (with DO and no urgency), 3A (with DO and moderate urgency), 3B (with DO and severe urgency), and 4 (with DO, severe urgency and chronic ischemic cerebral lesions). Urgency was graded as moderate or severe by the ability to avert an urgent void at cystometry for 2 or <2 min, respectively. BOO was assessed by the ‘‘Abrams^Gri⁄ths number’’ (AG) and bladder contractility by the parameters PIP and WF max . Results: AG did not di¡er signi¢cantly in Groups 2, 3A, and 3B, proved higher in such groups than in Group 1, and was nearly the same in Groups 1 and 4. PIP and WF max were signi¢cantly higher in Groups 2, 3A, and 3B than in Groups 1 and 4, had the highest levels in Group 3B, and did not di¡er signi¢cantly in Groups 1^4 and 2^3A. Conclusions: In DO patients with prostatic obstruction there seems to be a DO-related facilitation of bladder contractility. In the same patients, severe urgency of micturition might over-amplify (i.e., enhance a DO-related facilitation of) bladder contractility, provided there are no neurogenic (chronic ischemic cerebral) lesions. Neurourol. Uro- dynam. 24:202 ^206, 2005. ß 2005 Wiley-Liss, Inc. Key words: bladder contractility; bladder out£ow obstruction; bladder sensation; detrusor overactivity;urgency INTRODUCTION Often (although not always) the involuntary detrusor con- tractions identifying a condition of detrusor overactivity (DO) at cystometry (CMG) are immediately preceded and accompanied by urgency of micturition. This is a sudden, strong desire to urinate, associated with a sense of imminent leakage, which may result from fast stretch (detected by fast stretch receptors and conveyed to the cerebral cortex via C-¢bers) of relaxed smooth muscle cell areas in the bladder wall [Coolsaet et al., 1993]. An increased detrusor contrac- tion velocity (a typical characteristic feature of DO [Cucchi, 1998]) may contribute to the development of fast stretch in relaxed muscular zones surrounding involuntarily contract- ing muscle cell areas. In our clinical urodynamic practice, more than once we felt that a close link existed in DO patients between urgency of micturition and bladder contractile capability. In particu- lar, we had the impression there was an association between detrusor contraction strength and severe urgency. To verify this impression was now our aim in the present study. Here, we urodynamically assessed a population of non-DO and DO patients with and without urgency of micturition. Despite the small number of cases, it seemed that the data obtained were of some interest and so worth reporting. MATERIALS AND METHODS A retrospective analysis was performed of the urodynamic ¢ndings in 100 men with bladder out£ow obstruction (BOO) from benign prostatic enlargement who had been referred during the period June 1997öMay 2002 for obstructive and/or irritative symptoms of micturition. Exclusion criteria were urinary tract infection, stones or neoplasms; urethral or bladder neck stricture; diabetes mellitus; overt neuropathies (except for one patient series described below); mental distur- bances; or any other condition (or any drug treatment) that might interfere with bladder function, urine production rate, or voiding habits. *Correspondence to: Antonio Cucchi, MD, Divisione di Urologia, Policli- nico san Matteo, I-27100 Pavia, Italy. E-mail: c.cucchi1@virgilio.it Received 24 June 2004; Accepted 30 January 2005 Published online 24 March 2005 in Wiley InterScience (www.interscience.wiley.com) DOI 10.1002/nau.20128 ß 2005 Wiley-Liss, Inc.