Prevalence Of Detrusor Underactivity Research Articles

Age-specific prevalence, clinical and urodynamic findings of detrusor underactivity and bladder outlet obstruction in female voiding dysfunction.

Female voiding dysfunction with cystocele have been widely studied, but there are no data regarding women without cystoceles. The present study aimed to evaluate the prevalence of detrusor underactivity (DU) and bladder outlet obstruction (BOO) without cystoceles in a large sample size. This was a retrospective cohort study. Between April 1996 and September 2018, 602 neurologically intact women with voiding dysfunction without cystoceles were enrolled. Detrusor pressure (DU) at the maximum flow rate (PdetQmax) <20 cmH2O, maximum flow rate (Qmax) <15 mL/s, and a bladder voiding efficiency <90% and BOO (PdetQmax ≥40 cmH2O and Qmax <12 mL/s) were diagnosed by urodynamic study. Otherwise, a non-DU/BOO diagnosis was made. The prevalence of DU and BOO was the primary outcome. The secondary outcomes were the analyses of the differences between these three groups in objective UDS parameters and subjective questionnaires and bladder diary parameters. This study included 100 (17%) women with DU, 60 (10%) with BOO, and 442 (73%) with a non-DU/BOO diagnosis. DU increased with age, but BOO decreased as age increased. The women in the DU group were older, had higher parity and pad weights, and lower PdetQmax, maximum urethral closure pressure, and functional profile length than the BOO group. The urodynamic findings did not correlate well to subjective questionnaire parameters. None of the symptoms revealed a significant difference between the groups. The retrospective design was the limitation of the study. The prevalence of DU increased with age in women with voiding dysfunction without advanced cystoceles. Conversely, BOO decreased with age. Prevalence intersected in the fourth decade. Diagnosis requires urodynamic evaluation, as subjective symptoms are inconclusive.

Detrusor underactivity prevalence and risk factors according to different definitions in women attending urogynecology clinic

Introduction and hypothesisThere is still no consensus on definitions of detrusor underactivity; therefore, it is difficult to estimate the prevalence. The primary objective of the study was to evaluate the prevalence of detrusor underactivity in a cohort of patients with pelvic floor disorders according to different proposed urodynamics definitions. The secondary objectives were to estimate the association between detrusor underactivity and symptoms, anatomy and urodynamic findings and to build predictive models.MethodsPatients who performed urodynamic evaluation for pelvic floor disorders between 2008 and 2016 were retrospectively analyzed. Detrusor underactivity was evaluated according to Schafer’s detrusor factor, Abrams’ bladder contractility index and Jeong cut-offs. The degree of concordance between each method was measured with Cohenʼs kappa, and differences were tested using Student’s t test, Wilcoxon test and Pearson’s chi-squared test.ResultsThe prevalence of detrusor underactivity among a cohort of 2092 women, concerning the three urodynamic definitions, was 33.7%, 37.0% and 4.1%, respectively. Age, menopausal status, voiding/bulging symptoms, anterior and central prolapse, first desire to void and positive postvoid residual were directly related to detrusor underactivity. Conversely, stress urinary incontinence, detrusor pressures during voiding and maximum flow were inversely associated. Final models for detrusor underactivity resulted in poor accuracy for all considered definitions.ConclusionsThe prevalence of detrusor underactivity varies depending on the definition considered. Although several clinical variables resulted as independent predictors of detrusor underactivity, instrumental evaluation still plays a key role in the diagnosis.

The Prevalence of Detrusor Underactivity and its Symptoms Co-relation with Urodynamic Study Findings in Patients with Lower Urinary Tract Symptoms.

PurposeThis study determines the prevalence and clinical presentation of detrusor underactivity (DU) and its urodynamic characteristics in adult patients with lower urinary tract symptoms (LUTS).Patients and MethodsThis retrospective study has reviewed the symptoms and urodynamic study (UDS) findings of 283 patients with LUTS. Chi-square analysis was used to present the prevalence of UDS characteristics in both sexes.ResultsOut of records of 206 patients included in this study, fifty-one (24.76%) patients were diagnosed with DU based on bladder contractility index. Storage lower urinary tract symptoms were the most prevalent characteristic presentation in both sexes as compared to the difficulty in voiding, recurrent urine retention, and urinary incontinence. Bladder outlet, sphincter EMG findings, and degree of DU were significantly correlated with gender.ConclusionDU is a prevalent and sophisticated bladder pathology rather than a simple one. It requires more attention from the urologists, and evaluations, including UDS, to differentiate it from other pathologies.

Prevalence of Detrusor Underactivity and Bladder Outlet Obstruction in Female Without Cystocele

Prevalence of Detrusor Underactivity and Bladder Outlet Obstruction in Female Without Cystocele

Detrusor underactivity in pelvic organ prolapse.

The association between pelvic organ prolapse (POP) and detrusor underactivity (DU) is not well defined. The primary outcome of this study was to evaluate the prevalence of DU in a cohort of patients with POP and its association with symptoms, anatomy. and urodynamic findings. The secondary outcome was to evaluate the evolution of lower urinary tract symptoms after POP repair between DU and non-DU patients. Consecutive patients who underwent preoperative urodynamic tests were retrospectively analyzed. Detrusor underactivity was evaluated by the Bladder Contractility Index (BCI = pDetQmax + Qmax × 5) proposed by Abrams. A BCI < 100 was considered indicative of an underactive bladder. Patients with underactive bladder were considered group A, whereas the remaining patients were classified as group B. A total of 518 patients were studied. According to BCI, detrusor underactivity was identified in 212 (40.9%) patients (group A). Group A showed higher rates of voiding symptoms (59.4% vs 36.3%, p < 0.0001) and positive (>100ml) postvoid residual (29.7% vs 9.8%, p < 0.0001). Conversely, they displayed lower rates of urge incontinence (15.1% vs 23.2%, p = 0.02) and detrusor overactivity (15.6% vs 23.9%, p = 0.02). Preoperative Pelvic Organ Prolapse Quantification (POP-Q) demonstrated greater Aa (+1.1 ± 1.5 vs +0.9 ± 1.5, p = 0.03) and Ba (+1.4 ± 1.7 vs +1.2 ± 1.7, p = 0.04) points values in patients in group A. After POP surgery, postoperative voiding symptoms were similar in the two groups (16% vs 15.7%, p = 0.91). Our study showed a 40.9% prevalence of DU in POP patients. DU was associated with the presence of voiding symptoms and positive PVR. Moreover, cystocele showed to be more severe in DU group. After surgical repair of POP, voiding symptoms of DU patients became equal to non-DU ones, suggesting that obstruction removal might recover DU in these patients.

Physiopathologie de l’hypoactivité détrusorienne de la personne âgée

The aim of this study was to review the evidence regarding the pathophysiology of detrusor underactivity in the elderly. A literature review was conducted in July 2016 using the Medline/Pubmed database limiting the search to works in English or French. The prevalence of detrusor underactivity has been reported to range from 8% to 48% depending on the definition used and the age of the population studied. Current data suggest that aging may itself be a causative factor of detrusor underactivity through myogenic dysfunctions (ultrastructural degeneration of the detrusor muscle) and neurogenic dysfunctions (by degeneration of efferent but mostly afferent innervation mechanisms). Beyond these inherently age-related mechanisms, many comorbidities whose prevalence increase with age (diabetes, bladder outlet obstruction, estrogen deficiency, atherosclerosis, etc.) may be implicated in the development of detrusor underactivity in the elderly. The role played by detrusor overactivity in the appearance of detrusor underactivity must be considered separately as both seem to be the expression of the same condition of the lower urinary tract responding to different stages and secondary to numerous etiopathogenic factors which modulate its progression and clinical expressions. Pathophysiology of detrusor underactivity remains poorly understood but seems to imply myogenic and neurogenic factors which are favored, besides the aging per se, by various and numerous comorbidities which prevalence increase with age (diabetes, bladder outlet obstruction…).

PD26-11 SYMPTOMS AND NONINVASIVE PARAMETERS THAT PREDICT DETRUSOR UNDERACTIVITY IN MEN WITH LOWER URINARY TRACT SYMPTOMS: AN ANALYSIS USING A LARGE GROUP OF PATIENTS UNDERGOING PRESSURE FLOW STUDY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II1 Apr 2017PD26-11 SYMPTOMS AND NONINVASIVE PARAMETERS THAT PREDICT DETRUSOR UNDERACTIVITY IN MEN WITH LOWER URINARY TRACT SYMPTOMS: AN ANALYSIS USING A LARGE GROUP OF PATIENTS UNDERGOING PRESSURE FLOW STUDY Ryo Namitome, Mineo Takei, Ryosuke Takahashi, Tomoko Maki, Ken Lee, Shunichi Kajioka, Akito Yamaguchi, and Masatoshi Eto Ryo NamitomeRyo Namitome More articles by this author , Mineo TakeiMineo Takei More articles by this author , Ryosuke TakahashiRyosuke Takahashi More articles by this author , Tomoko MakiTomoko Maki More articles by this author , Ken LeeKen Lee More articles by this author , Shunichi KajiokaShunichi Kajioka More articles by this author , Akito YamaguchiAkito Yamaguchi More articles by this author , and Masatoshi EtoMasatoshi Eto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1219AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Underactive bladder (UAB) is a symptom complex suggestive of detrusor underactivity (DU). However, DU can be diagnosed at present only on the basis of an invasive pressure flow study (PFS), which has hampered the development of clinical research and effective treatment for UAB. Noninvasive diagnostic approaches for DU could potentially facilitate the diagnosis and research of this field. We therefore investigated to identify the noninvasive predictive factors for DU using a large group of patients undergoing PFS. METHODS We reviewed 2838 male patients who underwent PFS for lower urinary tract symptoms (LUTS). Age, International Prostate Symptom Score (IPSS), post-void residual volume (PVR), prostate volume (PV), and PFS parameters were obtained and analyzed. DU was defined as bladder contractility index <100. A multivariate logistic regression model was used to identify the factors associated with DU. RESULTS Of the patients, 1355 patients (46%) were classified as having DU. In univariate analysis, the prevalence of DU was significantly increased with increasing age (P<0.001) and PVR elevation (P<0.001), but decreased with increasing PV (P<0.001). The assessment of subjective symptoms using IPSS questionnaire revealed that patients with DU had a statistically significant higher occurrence of frequency (P=0.01), intermittency (P=0.001) and weak stream (P=0.01) compared with non-DU patients. On the other hand, the occurrence of urgency symptom (P<0.001) was significantly lower in DU patients. In multivariate analysis, increasing age, PVR elevation, small PV, and several symptoms including frequency, intermittency, weak stream and urgency were selected as predictive factors for DU. CONCLUSIONS Several symptoms (frequency, intermittency, urgency and weak stream), increasing age, PVR elevation and small PV could be predictive factors of male DU. Combined evaluation of these factors might be useful for the diagnosis and better understanding of the clinical presentation of male DU. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e510 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ryo Namitome More articles by this author Mineo Takei More articles by this author Ryosuke Takahashi More articles by this author Tomoko Maki More articles by this author Ken Lee More articles by this author Shunichi Kajioka More articles by this author Akito Yamaguchi More articles by this author Masatoshi Eto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Epidemiology of underactive bladder: Common but underresearched.

Detrusor underactivity (DU) or underactive bladder is a common cause of lower urinary tract symptoms (LUTS), but it is still poorly understood and underresearched. Although there has been a proposed definition by International Continence Society in 2002, no widely accepted diagnostic criteria have been established for this entity in clinical practice. Therefore, it has been rare to identify community-based researches on the epidemiology of DU until now. Only certain studies have reported the prevalence of DU in community-dwelling cohorts with significant LUTS using arbitrary urodynamic criteria for DU and these investigations have indicated that DU accounts for 25%–48% and 12%–24% of elderly men and women, respectively. However, these prevalence data based on the urodynamic definition apparently are limited in their extrapolation to the general population. Despite the clinical ambiguity of DU, its clinical effects on quality of life are quite significant, especially in the elderly population. An overall and proper comprehension of epidemiologic studies of DU may be crucial for better insight into DU, relevant decision making, and a more reasonable allocation of health resources. Therefore, researchers should find clues to the solution for the clinical diagnosis of this specific condition of LUTS from contemporary epidemiologic studies and try to develop a possible definition of ‘clinical’ DU from further studies.

Neurogenic Causes of Detrusor Underactivity.

Detrusor underactivity (DU) is a poorly understood dysfunction of the lower urinary tract which arises from multiple etiologies. Symptoms of DU are non-specific, and a pressure-flow urodynamic study is necessary to differentiate DU from other conditions such as overactive bladder (OAB) or bladder outlet obstruction (BOO). The prevalence of DU ranges from 10-48%, and DU is most prevalent in elderly males. The pathophysiology underlying DU can be from both neurogenic and non-neurogenic causes. In this article, we review the neurogenic causes of detrusor underactivity, including diabetic bladder dysfunction, spinal cord injury, multiple sclerosis, Parkinson's disease, cerebrovascular accident, traumatic brain injury, and Fowler's syndrome. As knowledge about the underlying causes of DU advances, there have been several potential therapeutic approaches proposed to help those who suffer from this condition.

Underactive Bladder: Clinical Features, Urodynamic Parameters, and Treatment.

Purpose:Underactive bladder is a complex clinical condition that remains poorly understood due to limited literature. This study aimed to determine its prevalence among patients with voiding dysfunction, presenting symptoms, risk factors, urodynamic findings, and ongoing treatment.Methods:A retrospective chart review of consecutive urodynamic studies performed on voiding dysfunction between 2012 and 2014 was conducted to identify patients with detrusor underactivity. Detrusor underactivity was defined by a bladder contractility index of less than 100. Charts and urodynamic tracings were examined for patient demographics, suspected risk factors, presenting symptoms, urodynamic parameters, and treatment undertaken. Descriptive statistics were utilized to analyze the data.Results:The prevalence of detrusor underactivity in this study was 23% (79 of 343). Average age of the patients was 59.2 years (range, 19–90 years). Women represented 68.4% (54 of 79) of the patients. The most common reported symptoms were urinary urgency (63.3%), weak stream (61.0%), straining (57.0%), nocturia (48.1%), and urinary frequency (46.8%). Prior pelvic surgery and prior back surgery were noted in 40.5% and 19.0% of the patients, respectively. The most common management was intermittent self-catheterization in 54.4%, followed by observation/conservative treatment in 25.3% and sacral neuromodulation in 12.7%.Conclusions:Although underactive bladder is a common condition, its precise diagnosis and treatment remain a challenge. Its symptoms significantly overlap with those of other bladder disorders, and hence, urodynamic evaluation is particularly useful in identifying patients with impaired detrusor contractility. This will help prevent mismanagement of patients with surgery or medical therapy, as that may worsen their condition. Much work needs to be done to better understand this condition and establish optimal management of patients.

Contemporary concepts in the aetiopathogenesis of detrusor underactivity.

Detrusor underactivity (DUA) is a poorly understood, yet common, bladder dysfunction, referred to as underactive bladder, which is observed in both men and women undergoing urodynamic studies. Despite its prevalence, no effective therapeutic approaches exist for DUA. Exactly how the contractile function of the detrusor muscle changes with ageing is unclear. Data from physiological studies in animal and human bladders are contradictory, as are the results of the limited number of clinical studies assessing changes in urodynamic parameters with ageing. The prevalence of DUA in different patient groups suggests that multiple aetiologies are involved in DUA pathogenesis. Traditional concepts focused on either efferent innervation or myogenic dysfunction. By contrast, contemporary views emphasize the importance of the neural control mechanisms, particularly the afferent system, which can fail to potentiate detrusor contraction, leading to premature termination of the voiding reflex. In conclusion, the contemporary understanding of the aetiology and pathophysiology of DUA is limited. Further elucidation of the underlying mechanisms is needed to enable the development of new and effective treatment approaches.

Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women

PurposeTo identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS).Materials and MethodsWe reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) ≤12 ml/s combined with a detrusor pressure at Qmax ≤10 cmH2O for men and women, respectively.ResultsOf the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU.ConclusionsDU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.

Urodynamic Evaluation of Patients with Lower Urinary Tract Symptoms and Small Prostate Volume

Introduction: The relevance of prostate size in the pathophysiology of lower urinary tract symptoms (LUTS) is controversial. We evaluated the urodynamic findings in patients with LUTS and small prostate volumes. Materials and Methods: 84 patients aged ≧50 years with LUTS and prostates <40 ml were evaluated. All had an International Prostate Symptom Score (IPSS) ≧8. Average age was 62.0 ± 8.1 years. We evaluated the impact of bladder outlet obstruction (BOO) and detrusor overactivity (DO) on the voiding symptoms and urodynamic findings. Results: Mean prostate volume was 29.2 ± 7.2 ml and mean IPSS was 13.5 ± 4.6. BOO was the main finding, affecting 42 (50.0%) patients, followed by detrusor underactivity (DU) in 41 (48.8%) and DO in 28 (33.3%) patients. Patients without BOO were significantly older than the obstructed (64.0 ± 8.8 and 60.1 ± 6.9 years, respectively; p = 0.026) and had an increased prevalence of DU (76.2 and 21.4%, respectively; p < 0.001). Comparison of patients with and without DO showed reduced bladder capacity and compliance in the DO group (p < 0.001). No other comparisons were significant. Conclusion: Half of the patients with LUTS and small prostates are not obstructed and may have DO or decreased detrusor contractility as the basis for their voiding symptoms. Our results emphasize the value of urodynamics in this population, especially when invasive treatments are being considered.

Re: Lai HH, Boone TB, Thompson TC, et al: Using Caveolin-1 Knockout Mouse to Study Impaired Detrusor Contractility and Disrupted Muscarinic Activity in the Aging Bladder. Urology 69: 407–411, 2007

Allan W Partin, MD, PhD Editor-in-Chief Urology TO THE EDITOR, In an important recent study, Lai et al.6 examined the impact of a caveolin-1 gene deletion on the amplitude of muscle contractility mediated by nerve stimulation and carbachol in detrusor muscle strips obtained from 3 and 12 months old male mice. Detrusor underactivity (DU) which has been defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span1 is a remarkably common problem among frail older adults who suffer from incontinence or other voiding difficulties12. The precise prevalence of DU among community-dwelling elderly remains unknown. Nevertheless, elevated post-void residuals are common in older individuals of both genders, while urodynamically documented DU in the absence of bladder outlet obstruction has been demonstrated in 59% of incontinent nursing home residents10. The clinical management of elderly individuals with DHIC (detrusor hyperactivity with impaired contractility) remains particularly unsatisfactory because antispasmodic anticholinergic medications may worsen retention, whereas bethanechol does not improve bladder emptying resulting from DU12. The dense band pattern with caveolar depletion has been described as being the ultrastructural pattern associated with normative bladder aging4, lack of estrogen15, diabetes11 and injury3. Many key signaling molecules including muscarinic and purinergic receptors are known to cluster in caveolae14. Moreover, the authors have previously demonstrated a decreased ability of cholinergic agonists to mediate bladder muscle contraction in mice rendered null for the caveolin-1 gene7. In view of the above considerations, we strongly agree with the decision Lai et al.6 to introduce age as a variable in examining the impact of caveolin-1 gene deletion on bladder muscle strip contractility. At the same time, we feel that the findings of their careful studies need to be attributed to maturational rather than aging processes8. In particular, we are concerned with the authors’ conclusion that since caveolin-1 −/− mice demonstrate a 50% decrease in their lifespan as compared to wild type caveolin-1 +/+ controls, 1 year old caveolin-1 −/− mice should be considered as being “aged”6. Certainly, mutations in some genes can result in premature aging syndromes both in humans and in some animal models2. Conditions such as progeria are felt to represent useful models for the study of aging since they are associated with an accelerated development of many of the phenotypic and biologic changes known to define normal aging2. In contrast, the dramatically reduced lifespan observed in caveolin-1 −/− mice appears to arise from the development of specific diseases in these mice including pulmonary fibrosis, pulmonary hypertension and cardiac hypertrophy, which result in decreased viability and premature death9. The presence of such early and ultimately lethal morbidity precludes the use of caveolin-1 −/− mice in traditional aging research. Nevertheless, caveolin-1 +/− mice could offer an extremely attractive and much-needed animal model of DU. As noted earlier, deletion of a single allele for the caveolin-1 gene appears to have no effect on the animals’ survival or viability9. Thus, It would be very interesting to know whether Lai et al.6 have examined the impact of caveolin-1 haploinsufficiency on bladder muscle contractility. In rodent models, lack of estrogen15, 16 results in quantitatively similar declines in bladder muscle contractility, numbers of caveolae per length of bladder muscle sarcolemma, and caveolin-1 protein levels. Thus, it is plausible that haploinsufficiency involving a single allele for the caveolin-1 allele in young (3 m. old)8 or mature (9–12 m. old)8 mice could result in detectable decreases in bladder muscle contractility. Furthermore, even if bladder muscle contractility proves to be similar in bladder muscle tissues obtained from younger caveolin-1 +/+ and caveolin-1 +/− mice, functional differences may only become apparent and detectable once haploinsufficient mice reach old age (21–26 m. old)13. Even if the impact of caveolin-1 gene haploinsufficiency on muscle contractility proves to be quite modest, these types of studies could represent an important contribution to research addressing the pathophysiology of DU in the frail elderly. Unlike many conditions seen in younger populations, multiple risk factors can contribute to DU5, 12. While the presence of any one single risk factor can only address a small portion of the overall risk of developing DU, the presence of multiple coexisting risk factors in any indvidual results in added risk, in many cases involving synergisms between different risk factors. Such considerations require the development of innovative investigative strategies for addressing the pathophysiology of complex multifactorial geriatric syndromes5.