Dynamics of obstruction in acontractile bladder: attempt at management

Five patients with acontractile bladders were observed during lateral voiding cystourethrography in the resting and straining states. Two abnormalities were noted: (1) posterior displacement of the bladder with closure of the posterior vesicourethral angle on straining, and (2) plication of the bladder over the symphysis pubis, resulting in the formation of an anterior pseudodiverticulum. Two other abnormalities are discussed: closure of the anterior vesicourethral angle, and descent of the bladder and prostate in flaccid paraplegia, causing plication at the prostatic apex. Surgical techniques for the correction of the abnormalities are described.