Detrusor underactivity: A plea for new approaches to a common bladder dysfunction (original) (raw)
Related papers
Neurourology and Urodynamics, 2018
The Think Tank aimed to discuss the pitfalls and advantages of current definitions in terms of research and management of underactive bladder (UAB). UAB broadly defines a symptom complex of bladder emptying problems and does not indicate a specific pathology. Detrusor underactivity (DU) is a urodynamic diagnosis from pressureflow studies. The correlation of UAB with DU remains to be precisely determined. Methods: The presentations and subsequent discussion, leading to research recommendations during the Think Tank of the International Consultation on Incontinence Research Society in Bristol, 2017, are summarized. Results: To develop more specific individualized management strategies, the Think Tank panel proposed (i) that, since defining a single type of index patient to represent all UAB will not fulfill all clinical research needs, several index patients should be defined by phenotyping of patients with UAB, including, children, young men and women, elderly male and female patients with co-existing DU and detrusor overactivity, and neurological patients with UAB; (ii) prospective longitudinal studies to assess the natural history of UAB, in the different target populations, based on different UAB phenotypes, should be initiated; (iii) DU should be precisely defined by urodynamic parameters; and (iv) work to develop validated specific questionnaires combined with non-invasive tests for screening, diagnosis and follow up, needs to be continued. Conclusions: The precise relationship of UAB to DU remains to be defined. Phenotyping patients with UAB/DU, performing prospective trials of natural history, and developing symptom questionnaires and diagnostic investigations will improve our ability to identify and treat UAB/DU.
European Urology, 2014
Context: Detrusor underactivity (DU) is a common cause of lower urinary tract symptoms (LUTS) in both men and women, yet is poorly understood and underresearched. Objective: To review the current terminology, definitions, and diagnostic criteria in use, along with the epidemiology and aetiology of DU, as a basis for building a consensus on the standardisation of current concepts. Evidence acquisition: The Medline and Embase databases were searched for original articles and reviews in the English language pertaining to DU. Search terms included underactive bladder, detrusor underactivity, impaired detrusor contractility, acontractile detrusor, detrusor failure, detrusor areflexia, raised PVR [postvoid residual], and urinary retention. Selected studies were assessed for content relating to DU. Evidence synthesis: A wide range of terminology is applied in contemporary usage. The only term defined by the standardisation document of the International Continence Society (ICS) in 2002 was the urodynamic term detrusor underactivity along with detrusor acontractility. The ICS definition provides a framework, considering the urodynamic abnormality of contraction and how this affects voiding; however, this is necessarily limited. DU is present in 9-48% of men and 12-45% of older women undergoing urodynamic evaluation for non-neurogenic LUTS. Multiple aetiologies are implicated, affecting myogenic function and neural control mechanisms, as well as the efferent and afferent innervations. Diagnostic criteria are based on urodynamic approximations relating to bladder contractility such as maximum flow rate and detrusor pressure at maximum flow. Other estimates rely on mathematical formulas to calculate isovolumetric contractility indexes or urodynamic ''stop tests.'' Most methods have major disadvantages or are as yet poorly validated. Contraction strength is only one aspect of bladder voiding function. The others are the speed and persistence of the contraction. Conclusions: The term detrusor underactivity and its associated symptoms and signs remain surrounded by ambiguity and confusion with a lack of accepted terminology, definition, and diagnostic methods and criteria. There is a need to reach a consensus on these aspects to allow standardisation of the literature and the development of optimal management approaches.
International braz j urol : official journal of the Brazilian Society of Urology
To evaluate the urodynamic characteristics of the two patterns (phasic, P and terminal, T) of detrusor overactivity (DO) according to gender and neurological condition. Urodynamic characteristics of DO were analysed in a population with proven urodynamic DO (127 women and 76 men, respectively with 48 and 43 neurological diseases (encephalic, incomplete medullar lesion or peripheral)). Phasic DO is characterized by phasic waves with or without leakage while terminal DO is defined by a single non-inhibited contraction resulting in incontinence. Parameters analysed for both patterns of DO (among other parameters) included: volume and amplitude of the first non-inhibited detrusor contraction (NIDC#1), and for phasic DO: duration of pressure rise during NIDC#1 and number of NIDC. Phasic DO was observed in younger patients in the whole population whatever the gender (women: 55.9 years vs. 64.7 years, p = 0.0052; men: 57.4 years vs. 67.8 years, p = 0.0038). Volume at NIDC#1 was greater for...
Eastern Journal Of Medicine, 2021
The aim of this study is to compare detrusor overactivity (DO) subtypes namely terminal (TDO) and phasic (PDO) in terms of frequency, etiologic reasons, urodynamic findings and relationships with neurological diseases. Patients' characteristics including age, gender, neurological diseases, were noted. Bladder volume on the first desire to voiding (FSD), the strong desire to voiding (SDV), maximum bladder capacity (MBC), bladder compliance (BC), presence and type of DO, and amplitude of DO (Ad) were also noted during the IUDS. Patients with TDO and PDO were compared in terms of patient characteristics, urodynamic parameters, and neurological diseases. 1018 patients were enrolled in the study. Neurological disease was noted in 180 patients; spinal cord trauma (
Urodynamic characteristics of detrusor underactivity in women with voiding dysfunction
PLOS ONE, 2018
Introduction and hypothesis Voiding dysfunction has gained interest due to its high prevalence in the elderly. This study characterized bladder dysfunction in women with voiding dysfunction using video urodynamic studies (VUDS) focused on detrusor underactivity (DU). Methods We studied 1914 women in which first-line medical treatment failed. Age, comorbidities, and urodynamic parameters were analyzed to determine the association between bladder sensation and contractility. Results VUDS were normal in 2.9% (n = 56) of patients and showed DU in 23.1% (n = 443), detrusor hyperactivity and impaired contractility (DHIC) in 12.0% (n = 231), hypersensitive bladder in 17.0% (n = 325), detrusor overactivity (DO) in 2.6% (n = 49) and bladder outlet obstruction in 42.3% (n = 810). The mean age of patients in the DU and DHIC groups was significantly older than in women with normal VUDS and those with hypersensitive bladders (p<0.01). Decreased bladder sensation and larger cystometric bladder capacity were noted in the DU group compared to the DHIC, HSB, and DO groups. Bladder sensation was negatively associated with the bladder contractility. Bladder contractility index and voiding efficiency were lower in the DU and DHIC groups compared to the normal group. Conclusions The bladder conditions of women with voiding dysfunction included DU, DHIC, HSB and DO. Bladder contractility index and voiding efficiency were significantly lowest in DU and DHIC groups and lower in HSB and DO groups than normal tracing group. Reduced bladder sensation was noted in DU and negatively associated with detrusor contractility.
Is the Bladder a Reliable Witness for Predicting Detrusor Overactivity?
The Journal of Urology, 2006
We determined how well the symptoms of OAB syndrome correlate with urodynamic DO using International Continence Society definitions. Materials and Methods: The study included adult males and females 18 years or older who attended a tertiary referral center for urodynamics from February 2002 to February 2004. Patients were selected based on OAB syndrome symptoms (urgency, urgency urinary incontinence and frequency). The percent of patients who had symptoms alone or in combination and DO was calculated. Results: There was a better correlation in results between OAB symptoms and the urodynamic diagnosis of DO in men than in women. Of men 69% and 44% of women with urgency (OAB dry) had DO, while 90% of men and 58% of women with urgency and urgency urinary incontinence (OAB wet) had DO. Stress urinary incontinence seems to have accounted for the decreased rates in women since 87% of women with urgency urinary incontinence also had the symptom of stress urinary incontinence. The ICS definition does not specify what constitutes abnormal voiding frequency. Analysis of results showed that increasing voiding frequency did not have any effect on increasing the accuracy of diagnosis of DO except in women with 10 or more daytime micturition episodes.
2018
Purpose To create a predictive model of involuntary detrusor contraction (IDC) to improve the diagnostic accuracy of overactive detrusor (OAD), associating overactive bladder (OAB) symptoms with other clinical parameters in the female population. Materials and Methods A total of 727 women were studied retrospectively. In all of them, urodynamic study was conducted for urogynecological causes. Demographics information, personal history, symptoms, physical exam, a 3-day frequency/volume chart and urinary culture, were collected in all patients and they subsequently underwent uroflowmetry and urodynamic studies. A logistic regression model was performed in order to determine independent predictors of presence of IDC. Odd ratio (OR) estimation was used to assign a score to each one of the significant variables (p≤0.05) in the logistic regression model. We performed a ROC curve in order to determine the predictive ability of the score in relation to the presence of OAD. Results presence ...
Research and Reports in Urology
This 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 Methods: This 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. Results: Out 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. Conclusion: DU 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.