Abstract
ObjectiveUnderactive bladder is frequently encountered in elderly patients. It may result from detrusor underactivity (DU) or low detrusor contractility due to a urethral sphincter inhibitory effect. This study analyzed the video-urodynamic study (VUDS) characteristics of patients with underactive bladder in a large cohort of men with lower urinary tract symptoms (LUTS).MethodsMale patients with LUTS who had failed the initial treatment were consecutively enrolled. All patients underwent detailed urological investigations including prostate measurement, free uroflowmetry, post-void residual volume (PVR) measurement, cystoscopy and VUDS. The VUDS characteristics of the men with underactive bladder were analyzed and compared with those of men with bladder outlet obstruction and normal tracing.ResultsA total of 1329 men who underwent VUDS were included in this retrospective analysis. After VUDS, the final diagnosis was DU in 165 patients, poor relaxation of external sphincter (PRES) in 525, bladder outlet obstruction in 501, and normal tracing in 138. VUDS findings in DU patients showed a slowly increased detrusor pressure, intermittent detrusor contractions, or early decline of detrusor contraction, resulting in a low maximum flow rate (Qmax), and large PVR. In comparison with the PRES groups, DU patients were older, had reduced bladder sensation, lower detrusor pressure (Pdet), lower Qmax, larger PVR volume, and lower voiding efficiency. Patients with urodynamic PRES also had low-pressure–low-flow tracings, but their bladder sensation was similar to that with normal tracing. DU patients with very low Pdet also had low detrusor tonicity, and more medical co-morbidities than the other groups did.ConclusionIdiopathic underactive bladder in elderly men could be attributed to urodynamic DU and PRES. DU is associated with old age, reduced bladder sensation, low voiding efficiency, and medical co-morbidities.
Highlights
Underactive bladder is frequently encountered in elderly patients with chronic medical or neurological diseases
Idiopathic underactive bladder in elderly men could be attributed to urodynamic detrusor underactivity (DU) and poor relaxation of external sphincter (PRES)
DU is associated with old age, reduced bladder sensation, low voiding efficiency, and medical co-morbidities
Summary
Underactive bladder is frequently encountered in elderly patients with chronic medical or neurological diseases. Underactive bladder causes lower urinary tract symptoms (LUTS) of hesitancy, slow stream, dysuria, and incomplete voiding. Patients with underactive bladder might have low detrusor contractility or a non-contractile detrusor; both are known as forms of detrusor underactivity (DU) in urodynamic terminology. In patients with DU, chronic urinary retention or large post-void residual (PVR) volume is frequently noted, which is usually difficult to manage. The pathophysiology of underactive bladder may involve neurogenic, myogenic, and bladder outlet pathologies [1]. Recent studies reveal that urothelial dysfunction of the urinary bladder may be associated with impaired bladder sensation as well as impaired detrusor contractility [2]
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