Neurourology and Urodynamics 31:317–321 (2012) What Are the Causes and Consequences of Bladder Overdistension?: ICI-RS 2011 Helmut Madersbacher, 1 * Linda Cardozo, 2 Christopher Chapple, 3 Paul Abrams, 4 Philip Toozs-Hobson, 5 John S. Young, 6 Jean-Jacques Wyndaele, 7 Stefan De Wachter, 8 Lysanne Campeau, 9 and Jerzy B. Gajewski 10 1 Department of Neurology, University Hospital Innsbruck, Innsbruck, Austria 2 Urogynaecology Department, King’s College Hospital, London, UK 3 Sheffield Teaching Hospitals NHS Trust, Sheffield, UK 4 Bristol Urological Institute, Southmead Hospital, Bristol, UK 5 Department of Gynaecology, Birmingham Women’s Hospital, Birmingham, UK 6 Department of Pharmacology, University of Oxford, Oxford, UK 7 University Antwerp and Antwerp University Hospital, Edegem, Belgium 8 Department of Urology, University Hospital Maastricht, Maastricht, The Netherlands 9 Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 10 Department of Urology, Dalhousie University, Halifax, Canada Aims: To report the outcome of the think tank on prolonged bladder overdistension from the 3rd ICI-RS meeting. Methods: Prolonged bladder overdistension was discussed after acute urinary retention, its terminology, its preva- lence, pathophysiology, and consequences, as well as prophylactic and therapeutic aspects. Results: Acute prolonged bladder overdistension (ApBO) is a consequence of undetected or inadequately treated acute retention, and is mostly due to regional anesthesia, prolonged childbirth, or extensive surgery. Currently, there is no agreed terminology. A primary, temporary neurogenic detrusor dysfunction causing retention is associated with decreased or absent bladder sensation therefore patients do not complain, and management is delayed. Therapeutically, the first intervention is to drain the bladder. Recovery depends on whether reversible or irreversible damage has occurred. There are no good data to support the use of drugs or sacral neuromodulation. Intravesical electrostimulation is the only treatment that has specifically addressed this problem with encouraging results. There are no recent reports on the effect of surgery for myogenic bladder damage. Conclusion: ApBO is an important, but often unrecognized medical complication. There is a need for defining the terminology, for studies to record the incidence of different types of bladder overdisten- sion, and to establish management strategies. Apart from clean intermittent self catheterizaiton (CIC) there are no data justifying pharmacological or other therapies. Therefore, prevention is of paramount importance and there is a need to develop and test preventative strategies, which should then be incorporated in surgical registries. Neurourol. Urodynam. 31:317–321, 2012. ß 2012 Wiley Periodicals, Inc. Key words: etiology; pathophysiology; prolonged bladder overdistension; therapeutic aspects INTRODUCTION Bladder overdistension is an important albeit uncommon medical complication usually seen in the context of obstetric practice, following from spinal or epidural anesthesia or after extensive pelvic/orthopedic surgery. It results in failure of bladder emptying for a prolonged period of time and is there- fore an important cause of significant long-term lower urinary tract morbidity and litigation. No one has adequately defined the nature of bladder overdistension or what is meant by this term. Most studies focus on postoperative urinary retention (PUR), which, if left undetected, will lead to acute, prolonged overdistension. As normal bladder capacity ranges from 400 to 600 ml, volumes higher than 600 ml can be regarded as leading to overdistension and in a normal individual will cause discomfort and/or pain. 1 Amundsen et al. 2 correlated functional bladder capacity in asymptomatic women with 24-hr urine output (increased) and age (slightly decreased). The nature of overdistension discussed here is acute disten- sion occurring in an individual where the bladder becomes anatomically overdistended for a prolonged period of time. Neither the degree of distension nor the duration which lead to untoward sequelae has been defined. Currently, there are no scientific data available relating to patient management following acute bladder overdistension nor any data describ- ing the long-term outcome of bladder overdistension. TERMINOLOGY Acute prolonged bladder overdistension (ApBO) is defined by a bladder filling volume at the time of diagnosis of at least 120% of a normal bladder capacity, which has lasted at least 24 hr. 3 It is not usually associated with bladder outlet obstruction, but is usually a consequence of a spinal or epidural anesthetic, prolonged childbirth, or extensive pelvic or orthopedic surgery. Because of lack of pain or discomfort (see below) therapeutic intervention is usually delayed. There- fore, ApBO is a consequence of undetected or inadequately treated acute urinary retention. Diuresis as a result of an Karl-Erik Andersson led the review process. Conflict of interest: None. *Correspondence to: Helmut Madersbacher, Professor, Department of Neurology, University Hospital Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. E-mail: helmut.madersbacher@tilak.at Received 10 January 2012; Accepted 13 January 2012 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/nau.22224 ß 2012 Wiley Periodicals, Inc.