Diagnosis of Underactive Bladder in Male

Abstract

AbstractUnderactive bladder (UAB) is a lower urinary tract symptoms (LUTS) syndrome characterised by a slow urinary stream, hesitancy, and straining to void, with or without a feeling of incomplete bladder emptying and dribbling, often with storage symptoms; these symptoms are suggestive of urodynamic demonstrable detrusor underactivity (DU), but can be caused by other forms of urethro-vesical dysfunctions. UAB includes clinical definitions based on LUTS and signs that do not rely on urodynamic criteria. The main diagnostic flow results from integrated clinical and instrumental methods and comprises symptom collection, medical history, bladder diary, urological physical examination, urinalysis, uroflowmetry with post void residual (PVR), invasive urodynamic pressure/flow study (PFS). UAB may be associated to a multifactorial aetiology that should be investigated, as well as the presence of bladder outlet obstruction (BOO) in man should be always considered. The PFS is the only conclusive method to diagnose DU and may be particularly necessary in unclear cases or those not responding to initial treatment of the most troublesome symptoms, but it involves methodological limitations, because of the lack of specific markers for DU. One question that deserves to be addressed is whether it is possible to develop an integrated diagnostic tool based on a combination of symptoms, signs and specific urodynamic markers to diagnose UAB based on specific personal phenotypes.KeywordsLower urinary tract symptoms (LUTS)Underactive bladder (UAB)Detrusor underactivity (DU)Post void residual (PVR)Urodynamic pressure/flow study (PFS)