How does detrusor overactivity present on urodynamics?

• A. Detrusor overactivity is voluntary detrusor contractions during the filling phase.
• B. Detrusor overactivity is involuntary detrusor contractions during filling, leading to urgency and potential leakage.
• C. Detrusor overactivity is the absence of detrusor contractions.
• D. Detrusor overactivity occurs only during voiding.

Answer: (B)

Detrusor overactivity on urodynamics is defined by involuntary detrusor contractions occurring during the bladder filling phase. These contractions are not under voluntary control and are often associated with a sense of urgency, and they may lead to leakage if the contraction reaches a threshold that overcomes the bladder capacity. On filling cystometry, you’d see sudden spikes in detrusor pressure during filling, sometimes with leakage accompanying the contraction. The other patterns don’t fit because voluntary contractions during filling are under conscious control and not pathological; absence of contractions points to an acontractile detrusor; contractions that occur only during voiding reflect activity in the voiding phase rather than the filling phase.