Detrusor Underactivity and Detrusor Hyperactivity with Impaired Contractility

Abstract

Detrusor underactivity (DU) is a condition of impaired bladder contraction strength or duration resulting in impaired bladder emptying. In contrast, detrusor hyperactivity with impaired contractility (DHIC) is a condition in which patients paradoxically exhibit detrusor overactivity during storage yet are unable to mount a sufficient detrusor contraction during voiding to completely empty the bladder. Both conditions are often mistaken for bladder outlet obstruction. These conditions are more commonly seen in institutionalized elderly patients with either urinary retention or incontinence. To date, the exact etiologies of DU and DHIC remain unclear. Accurate diagnosis is based on clinical suspicion, complete history and physical exam, and videourodynamic evaluation. However, in certain patients, such as frail elderly patients, a full workup may not be warranted if it will not influence treatment decisions. Treatment of these disorders is primarily based on patient bother, with behavior modification first implemented, followed by pharmacotherapy with addition of CIC or indwelling catheter as indicated.