Clinical and urodynamic characteristics of underactive bladder

Abstract

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.

Management of Urinary Incontinence With Underactive Bladder: A Review

“…The urodynamic findings of UAB include DU, an acontractile detrusor, and detrusor hyperactivity with impaired contractility (DHIC). Although DHIC is associated with urgency urinary incontinence (UUI), it does not account for much of the UAB population [7]. SUI, a type of urethral sphincter dysfunction, is more likely to be associated with UAB involving incontinence.…”

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

“…The voiding difficulty might be aggravated by using antimuscarinics for the treatment of DO, resulting in chronic or acute urinary retention in patients with DU and DO respectively. 22 Medical treatment has been given to the majority of the patients, which might be reflected with missed diagnosis due to the long duration of the prevalent problem and overlap of DU characteristics with other common symptoms such as bladder overactivity, urinary tract infections, and BOO. 23 , 24 The findings of the current study are supported by the findings of Rademakers et al, 25 who reported a prevalent increase of hesitancy, weak stream, and incomplete bladder emptying in women with DU as compared to men.…”

Electrical stimulation for neuroregeneration in urology

“…Since cavernous nerve injury during pelvic surgery results in erectile dysfunction in 50% of male patients, this is an active area of neuroregeneration research [35]. While not currently being investigated, these approaches could also be used to prevent underactive bladder symptoms, which can be caused by SCI, pelvic fractures, or nerve injury during pelvic surgery [36]. Any therapy that could increase regeneration associated genes would also help neuroregeneration after injuries or trauma when normal upregulation is either blunted or non-existent, such as occurs in childbirth which results in impaired regeneration of the pudendal nerve and reinnervation of the external urethral sphincter [37,38].…”