Detrusor Underactivity and Bladder Outlet Procedures in Men

Abstract

Detrusor underactivity (DU) is a common but poorly understood clinical problem. The diagnosis and treatment of DU are difficult and full of uncertainties. There are many overlaps between DU and bladder outlet obstruction (BOO) in clinical symptoms and managements. In this review, we discuss the relationship of clinical diagnosis and treatment between DU and BOO in men, especially the outcome of bladder outlet surgery in patients with DU. DU could be resulted from many different etiologies, including psychogenic, neurogenic, myogenic, and the reduced detrusor contractility after increasing muscle work against the increase of bladder outlet resistance. Current managements are usually focused on relieving voiding difficulty and prevent urine retention to avoid urinary tract infection and upper urinary tract deterioration. Since there is no suitable medical treatment to enhance bladder contractility, most of the researches focus on reducing bladder outlet resistance and treat BOO. Many recent studies have reported the therapeutic outcome of transurethral incision of the bladder neck, transurethral resection of the prostate and urethral sphincter botulinum toxin A injection. The current treatment options in DU are limited. Even if there are many clinical trials revealing good results in patients with DU after BOO surgery, the evidence that BOO surgeries benefit patients with DU are still controversial. The actual mechanism of detrusor function recovery after BOO surgery in men with DU has not been well elucidated. Nevertheless, a portion of men with DU can safely and effectively improve their voiding symptoms and voiding efficiency after BOO surgeries. Further research of the underlying pathophysiology between DU and BOO is mandatory.