There have no universally accepted criteria and have been established for classification of underactive bladder (UAB) at present. Thus, the study described the comprehensive clinical and urodynamic characteristics of UAB in patients with lower urinary tract symptoms.A total of 1726 patients (1259 men and 467 women; 6–88 years old) who were admitted to our center with a diagnosis of UAB were included in this retrospective study. It was due to the type of rehabilitation hospital, so higher percentage of neurological patients were included. The demographics, clinical characteristics, and urodynamic recordings were reviewed. The clinical characteristics and urodynamic findings of UAB were further classified.For the etiologic analysis, UAB with aging and without clear causes accounted for 11.5% of cases (199/1726), UAB with bladder outflow obstruction accounted for 2.6% (45/1726), and UAB acting on the nerve pathway of the voiding reflex accounted for 84.6% (1460/1726). There were a number of cases (1.3% [22/1726]) which had >2 factors assigned. For studies involving urodynamic findings and clinical symptoms, the percentage of patients with detrusor hyperreflexia with impaired contractility (DHIC), detrusor underactivity (DU), and acontractile detrusor (AcD) was 0.7%, 5.6%, and 93.7%, respectively.UAB can be classified into 4 types based on possible etiologic mechanisms (idiopathic, myogenic, neurogenic, and integrative). Based on urodynamic findings and symptoms, UAB can be classified into 3 types (DU, AcD, and DHIC). The classification of UAB can provide a reasonable basis for the future research.
PurposeWe investigated the effects of different stimulation frequencies on the inhibition of bladder overactivity by sacral neuromodulation (SNM) in pigs.MethodsImplant-driven stimulators were used to stimulate the S3 spinal nerve in 13 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM (pulse width, 210 µsec) at frequencies ranging from 5 to 50 Hz was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different frequencies on the micturition reflex.ResultsAA-induced bladder overactivity significantly reduced the bladder capacity (BC) to 34.4%±4.7% of the NS control level (354.4±35.9 mL) (P<0.05). During AA infusion, SNM at 5 Hz did not significantly change the BC (48.1%±6.9% of the NS control level) (P>0.05), but SNM at 15, 30, and 50 Hz significantly increased the BC to 54.5%±7.1%, 55.2%±6.5%, and 57.2%±6.1% of the NS control level (P<0.05), respectively. No significant differences were found among the results obtained using frequencies of 15, 30, and 50 Hz (P>0.05).ConclusionsThis study demonstrated that 15 Hz was an appropriate frequency for SNM and that frequencies higher than 15 Hz did not lead to better surgical outcomes.
This study showed the effective inhibition on bladder activity under both non-nociceptive and nociceptive conditions, suggesting the possibility of sacral DRG stimulation to treat bladder overactivity.
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