A new look at detrusor underactivity: Impaired contractility versus afferent dysfunction

Suskind, Anne M.; Smith, Phillip P.

doi:10.1007/s11934-009-0055-2

Cited by 36 publications

(29 citation statements)

References 38 publications

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“…Similar findings in autonomic nerve innervation were observed in human bladder with bladder outlet obstruction . The data may show the contribution of insufficient activation of cholinergic neurons to the decreased contractility of detrusor muscles . Using human detrusor smooth muscle strips, we also demonstrated that the cholinergic component of electrical field simulation‐induced contraction was significantly decreased with aging, and that there was significant negative correlation between cholinergic contraction and aging …”

Section: Efferent Dysfunction and A Decrease Of Detrusor Muscle Contrsupporting

confidence: 80%

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Detrusor Underactivity: The Current Concept of the Pathophysiology

Yoshida

Yamaguchi

2014

LUTS

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Based on evidence from available literature, we review the pathophysiology of detrusor underactivity (DU). DU is likely to be multifactorial. Aging reduces detrusor activity, but other concomitant causes may aggravate this condition, resulting in decrease of detrusor contractility. Impaired detrusor contractility has been regarded as a major etiologic factor of DU. However, a more complex pathology has been proposed. As contributing factors to DU, we discuss disturbances of the sensory afferent side of the micturition reflex, the central nervous system (CNS) and the efferent side of the reflex, including nerves and the detrusor muscle. Particularly, dysfunction of afferent nerves in the bladder and urethra may play a crucial role in the pathogenesis of DU. In addition, recent studies suggest that chronic bladder ischemia and resultant oxidative stress cause detrusor overactivity progressing to DU and inability to empty the bladder.

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Section: Efferent Dysfunction and A Decrease Of Detrusor Muscle Contrsupporting

confidence: 80%

“…Currently, it has been suggested that DU may result from disturbances of not only the detrusor but also sensory afferent pathway, central nervous systems (CNS), and motor efferent nerves (Fig. ).…”

Section: Introductionmentioning

confidence: 99%

Detrusor Underactivity: The Current Concept of the Pathophysiology

Yoshida

Yamaguchi

2014

LUTS

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“…The pathogenesis of DU is multifactorial, and many diseases or disorders can cause DU [24]. Long term of single bladder outlet obstruction can impair detrusor contractility leading to the decrease of the contractility [25].…”

Section: Discussionmentioning

confidence: 99%

Photoselective Vaporization of the Prostate and Simultaneous Suprapubic Cystostomy for the Treatment of Benign Prostatic Hyperplasia in Patients with Mild to Severe Detrusor Underactivity

Zhao-yi

et al. 2015

Urol Int

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Introduction: This study investigated the clinical efficacy and safety of photoselective vaporization of the prostate (PVP) and simultaneous suprapubic cystostomy for benign prostatic hyperplasia (BPH) in patients with mild to severe detrusor underactivity (DU). Subjects and Methods: Seventy-eight patients with BPH were divided into 3 groups according to the severity of DU: mild DU group, moderate DU group and severe DU group. The preoperative and postoperative data, including the detrusor pressure at maximum flow (Pdet_max), bladder compliance, maximum urinary flow (Q_max), postvoid residual urine (PVR) values, International Prostate Symptom Score (IPSS) and quality of life (QoL) were evaluated. Results: The therapeutic effectiveness including cure and improvement in mild and moderate DU group was significantly higher than that of the severe group. Compared to the preoperative values, Pdet_max, bladder compliance, Q_max, PVR, IPSS and QoL scores at 12 months postoperatively had significantly improved. In addition, the above parameters at 12 months postoperatively in the mild or moderate DU group had significant difference compared to the severe DU group. Conclusion: PVP and simultaneous suprapubic cystostomy seem to be an appropriate treatment modality in BPH patients with mild and/or moderate DU as well as in patients with severe DU and slightly reduced bladder compliance.

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“…Cukorbetegség során kialakult neuropathia a vizelé-si reflex csökkenéséhez, illetve megszűnéséhez vezethet [14]. Tanulmányunkban egyértelmű összefüggést mutattunk ki a BCI csökkenése és neurológiai kórképek, diabetes között (p = 0,042, p = 0,008).…”

Section: Megbeszélésunclassified

A hólyagkontraktilitási index meghatározásának fontossága a csökkent hólyagműködés kezelésében

et al. 2017

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Célkitűzés: A hólyagkontraktilitási index (BCI) fontosságának felmérése a csökkent hólyagműködés kezelésében. Betegek és módszer: Retrospektív tanulmányunkban 2013. január és 2016. szeptember közötti, detrusor-alulműködés-sel (BCI<100) kórismézett beteg adatait dolgoztuk fel (BCI = PdetQmax+5Qmax). Eredmények: A tanulmányozott betegek (férfi 38, nő 53) esetében a BCI átlagértéke 55 volt (17-110), urodinámiás vonatkozásban: átlag-Qmax 7 ml/s, átlag-Pdet 14 H 2 O-cm. A BCI csökkenő tendenciát mutat az életkor előreha-ladtával, valamint összefüggés mutatható ki a BCI, a diabetes (p = 0,003), illetve a neurológiai betegségek (p = 0,015) között. Következtetések: A csökkent hólyagműködés kórismézése igazi kihívás az urológus számára, az urodinámiás vizsgála-tok (a residuum értéke, Qmax, PdetQmax) és a BCI értéke nagyban elősegítik a megfelelő kezelési terv felállítását. Orv Hetil. 2017; 158(31): 1222-1227. Kulcsszavak: urodinámiás, detrusor-alulműködés, hólyagkontraktilitási index The importance of Bladder Contractility Index in the management of underactive bladderAim: To evaluate the importance of BCI in the management of underactive bladder (UB). Material and method: A retrospective study over a period of 3 years and 9 months (January 2013-September 2016 in Mureş County Hospital, Clinic of Urology, including 91 patients. Detrusor underactivity was defined by BCI less than 100 using the formula: PdetQmax+5Qmax. Results: The median of Qmax value was 7 ml/s and the median value of Pdet was 14 cm H 2 O. The median value of BCI was 55 with extremities between 17 and 110. BCI tends to decrease with age and there is a relation between value of BCI and diabetes (p = 0,003) and neurological diseases (p = 0,015). Conclusions:The UB diagnosis represents a real challenge for the urologist, so that, urodynamical findings such as absence of bladder obstruction, post-void residual urine, Qmax, together with BCI value, helps in setting the proper management.

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A new look at detrusor underactivity: Impaired contractility versus afferent dysfunction

Cited by 36 publications

References 38 publications

Detrusor Underactivity: The Current Concept of the Pathophysiology

Detrusor Underactivity: The Current Concept of the Pathophysiology

Photoselective Vaporization of the Prostate and Simultaneous Suprapubic Cystostomy for the Treatment of Benign Prostatic Hyperplasia in Patients with Mild to Severe Detrusor Underactivity

A hólyagkontraktilitási index meghatározásának fontossága a csökkent hólyagműködés kezelésében

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