Prevalence of Detrusor After-Contraction and Concomitant Urodynamic Findings: A Systematic Review and Exploratory Analysis of an Understudied Urodynamic Phenomenon.

Abstract

Purpose: Detrusor after-contraction (DAC) is a urodynamic phenomenon whose clinical relevance remains contested, largely because no formal operational definition has been established. We conducted the first systematic review of DAC to characterize the definitional and methodological heterogeneity underlying its reported prevalence and its co-occurrence with other urodynamic findings. Exploratory quantitative pooling was performed to illustrate the magnitude of this heterogeneity, not to establish a clinically generalizable prevalence estimate.

Methods: PubMed and Scopus were searched from inception through February 2026 (PROSPERO: CRD420251131496). Studies reporting DAC prevalence with extractable numerator/denominator data in mostly adult (≥18 years), non-neurogenic populations were included. Pooled estimates were calculated using random-effects models with logit transformation and Hartung-Knapp adjustment. Risk of bias was assessed using a checklist adapted from the JBI Critical Appraisal Checklist.

Results: Five studies (n = 7,131 patients) were included, applying at least four distinct operational definitions of DAC. Between-study heterogeneity was extreme (I² = 98.2%); an exploratory pooled DAC prevalence of 12.98% (95% CI 4.80-30.62%) is reported to illustrate this instability, with a 95% prediction interval (1.06-67.54%) spanning nearly the entire plausible range of proportions. Among DAC-positive patients, detrusor overactivity co-occurred in an exploratory pooled proportion of 48.57% (95% CI 25.50-72.26%; I² = 81.9%); in the absence of a DAC-negative comparator, this reflects co-occurrence rather than a demonstrated association. Pooled estimation of bladder outlet obstruction was not undertaken given incompatible definitional criteria across the only two studies providing extractable data (16.7% vs. 77.8%).

Conclusions: The principal contribution of this review is the substantial definitional and methodological heterogeneity across studies of DAC, which precludes a clinically generalizable prevalence estimate. Detrusor overactivity co-occurs in approximately half of DAC-positive patients, an observation that warrants investigation with DAC-negative comparators before causal or associative interpretations can be drawn. Adoption of a uniform operational definition is necessary before meaningful comparisons across cohorts can be achieved.