Clinical features of detrusor underactivity in elderly men without neurological disorders

Abstract

Objectives: To investigate the clinical features of detrusor underactivity (DU) in elderly men without neurological disorders. Methods: A total of 336 men aged ≥50 years without neurogenic disorders who underwent pressure flow studies and who had DU or bladder outlet obstruction (BOO) were reviewed retrospectively. According to the bladder contractility index (BCI) and the BOO index (BOOI), the subjects were classified into the following three groups: (a) pure DU group, BCI < 100 and BOOI < 40; (b) DU + BOO group, BCI < 100 and BOOI ≥ 40; and (c) pure BOO group, BCI ≥ 100 and BOOI ≥ 40. Subjective and objective parameters were compared among the three groups, and the predictors for pure DU were evaluated by multivariate analysis. Results: Of the 336 patients, 205 who met the study criteria were included in the analysis: 63 (30.7%) with pure DU, 48 (23.4%) with DU + BOO, and 94 (45.9%) with pure BOO. The proportion of the pure DU group increased with increasing age. Prostate volume was the lowest in the pure DU group. Frequency, urgency on the International Prostate Symptom Score (IPSS), and the IPSS storage subscore were the lowest in the pure DU group. Multivariate analysis showed that age (odds ratio [OR] 1.114 [95% CI, 1.032-1.203], P = .005), prostate volume (OR 0.968 [95% CI, 0.949-0.987], P = .001), and urgency (OR 0.623 [95% CI, 0.431-0.900], P = .012) were predictors of pure DU. Conclusion: Older age, smaller prostate volume, and less urgency may be clinical features of pure DU.

Two types of detrusor underactivity in men with nonneurogenic lower urinary tract symptoms

“…In contrast, men with DU without SD had increased bladder capacity and little increase in detrusor pressure during the storage phase in UDS and had significantly more severe voiding symptoms, such as straining to void. Some reports have concluded that lower urgency and decreased bladder sensation are characteristic features in men with nonneurogenic DU 5,6 . However, in the present study, of 212 men with urodynamic DU, 123 (58.0%) men had SD in UDS, 123 (58.0%) men met the diagnostic criteria for OAB in Japan, and UUI was also observed in 95 (44.8%) men.…”

“…Some reports have concluded that lower urgency and decreased bladder sensation are characteristic features in men with nonneurogenic DU. 5,6 However, in the present study, of 212 men with urodynamic DU, 123 (58.0%) men had SD in UDS, 123 (58.0%) men met the diagnostic criteria for OAB in Japan, and UUI was also observed in 95 (44.8%) men. Gammie et al 8 reported that 123/250 (49.2%) men with DU (BCI < 100, BOOI < 20, and BVE < 90%) had DO and that patients with DU and DO were older, had more urgency episodes and had lower bladder volumes than men with DU without DO.…”

“…Recently, some studies have aimed to identify the characteristic symptoms that can predict the presence of urodynamic DU 3–6 . A study based on a large European database of urodynamic studies (UDS) identified decreased sensation, in addition to strain‐to‐void and incomplete bladder emptying, as the characteristic symptoms of men with DU 4 .…”

“…Recently, some studies have aimed to identify the characteristic symptoms that can predict the presence of urodynamic DU. [3][4][5][6] A study based on a large European database of urodynamic studies (UDS) identified decreased sensation, in addition to strain-to-void and incomplete bladder emptying, as the characteristic symptoms of men with DU. 4 Takahashi et al 5 reported that older age, smaller prostate volume, and fewer urgency symptoms were significant predictive factors for differentiating DU in men with LUTS.…”

Relationship between lower urinary tract symptoms and frailty

“…[1][2][3][4][5][6][7][8][9] Both LUTS and frailty are related to multiple comorbidities and unfavorable outcomes, such as reduced physical activity, hospitalizations, falls, impaired cognition, and poor quality of life. [10][11][12][13][14][15][16][17][18][19] Furthermore, several studies have revealed close associations between LUTS and frailty. [4][5][6][7][8] Since LUTS and frailty have complex relationships, it is difficult to define their association.…”