Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients

Resnick, Neil M.; Yalla, Subbarao V.

doi:10.1001/jama.257.22.3076

Cited by 262 publications

(157 citation statements)

References 22 publications

Supporting

Mentioning

143

Contrasting

Unclassified

Order By: Relevance

“…DHIC, is a common condition in frail elderly individuals (12), and DUA increases in the same way; these two latter behaviors lead respectively to UI with high PVR and to chronic retention. The decrease of detrusor contractility with ageing can be related to the decrease in caveolae, bladder weight and smooth muscle density with age (3).…”

Section: Commentsmentioning

confidence: 99%

“…Detrusor overactivity (involuntary detrusor contraction during the filling phase, DO) (9-11) and its subset detrusor hyperactivity with impaired contractility (DHIC) (12) were found in a total of 142 patients (32%) with a significant increase in group C: 43% vs. 23% A & 30% B (p = 0.0004); detrusor underactivity (impaired detrusor contraction leading to prolonged voiding time and high residual volume) (DUA) (9) was found in 62 patients (14%) with also a significant increase in C (p = 0.0024). Normal detrusor behavior significantly decreased in C (p = 0.005).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Urodynamics in women from menopause to oldest age: what motive? what diagnosis?

2011

View full text Add to dashboard Cite

Purpose: To analyze age-associated changes as a motive for urodynamics and urodynamic diagnosis in community-dwelling menopausal women and to discuss the role of menopause and ageing. Materials and Methods: Four hundred and forty nine consecutive menopausal women referred for urodynamic evaluation of lower urinary tract (LUT) symptoms, met the inclusion criteria and were stratified into 3 age groups: 55-64 years (A), 65-74 years (B), and 75-93 years (C). Comprehensive assessment included previous medical history and clinical examination. Studied items were motive for urodynamics, results of uroflows (free flow and intubated flow) and cystometry, urethral pressure profilometry, and final urodynamic diagnosis. Results: The main motive was incontinence (66.3%) with significant increase of mixed incontinence in group C (p = 0.028). Detrusor function significantly deteriorated in the oldest group, mainly in absence of neurological disease (overactivity p = 0.019; impaired contractility p = 0.028). In the entire population, underactivity predominated in group C (p = 0.0024). A progressive decrease of maximum urethral closure pressure occurred with ageing. In subjects with no detrusor overactivity there was a decrease with age of detrusor pressure at opening and at maximum flow, and of maximum flow while post void residual increased only in the C group. Conclusion: In our population of community-dwelling menopausal women, incontinence was the main motive for urodynamics increasing with ageing. A brisk change in LUT function of women older than 75 years underlined deterioration in bladder function with a high incidence of detrusor hyperactivity with or without impaired contractility while change in urethral function was progressive. Effect of ageing appears to be predominant compared to menopause.

show abstract

Section: Commentsmentioning

confidence: 99%

mentioning

confidence: 99%

Urodynamics in women from menopause to oldest age: what motive? what diagnosis?

2011

View full text Add to dashboard Cite

show abstract

“…34 Post void residual (PVR) urine is frequently the cause of UI in frail elderly patients and ''clinical observation'' suggests that fecal loading can frequently be a cause of ineffective emptying. 35 On this basis, the ICI-CDT recommends PVR measurement by a non-invasive method, and attention to rectal filling and defecation, before any treatment of UI in the frail elderly.…”

Section: Urodynamic Testing Frail Elderly With Signs And/or Symptoms mentioning

confidence: 99%

Executive summary: The International Consultation on Incontinence 2008—committee on: “Dynamic Testing”; for urinary or fecal incontinence. Part 2: Urodynamic Testing in male patients with symptoms of urinary incontinence, in patients with relevant neurological abnormalities, and in children and in frail elderly with symptoms of urinary incontinence

Szabo

Capewell

Gajewski

et al. 2009

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aims:The members of 'The International Consultation on Incontinence 2008 (Paris) Committee on Dynamic Testing' provide an executive summary of the chapter 'Dynamic Testing' that discusses (urodynamic) testing methods for patients with signs and or symptoms of urinary incontinence. Testing of patients with signs and or symptoms of fecal incontinence is also discussed. Methods: Evidence based and consensus committee report. Results: The chapter 'Dynamic Testing' is a continuation of previous Consultation reports added with a new systematic literature search and expert discussion. Conclusions, based on the published evidence and recommendations, based on the integration of evidence with expert experience and discussion are provided separately, for transparency. Conclusion: This second part of a series of three articles summarizes the committee's recommendations about: 'Urodynamic testing of male patients with symptoms of incontinence, of patients with relevant neurological abnormalities, testing of children and of frail elderly with symptoms of incontinence' and includes only the most recent and relevant literature references. Neurourol. Urodynam. 29:146-152, 2010. ß 2009 Wiley-Liss, Inc.Key words: consensus committee; incontinence (children); incontinence (frail elderly); incontinence (male); incontinence (neurologic); urodynamics INTRODUCTIONSubsequent to the first two reports of the International Consultation on Incontinence (ICI) 1,2 the chapter ''Urodynamic Testing'' was renamed ''Dynamic Testing'' in the third and fourth reports because of the additional inclusion of recommendations on the (diagnostic) management of fecal incontinence. 3 We (members of ''The ICI 2008 Committee on Dynamic Testing'': ICI-CDT) provide an executive summary of the chapter ''Dynamic Testing'' in the fourth ICI-report on incontinence. 4 The ICI-report, with the ICI-CDT chapter discussed here, has the intention to provide recommendations on the basis of the most reliable evidence for the current state of assessment of the patient with urinary or fecal incontinence. To this aim, dedicated and systematic literature searches were performed on the basis of keywords and on the basis of articles related to references in the previous ICI-reports. Throughout the chapters' text ''conclusion(s)'': solely and entirely based on the published scientific evidence, and ''recommendation(s)'' are highlighted. The ''recommendations'' are the integration of scientific evidence with the expert group consensus, together with the discussion with the attendees during the ICI meeting. Conclusions are separated from recommendations to produce maximum transparency about the ''evidence base'' of the recommendations. Likewise obtained ''topics(s) for research'' are also highlighted in the text of the ICI-report. In this executive summary, we discuss the chapter ''Dynamic Testing'' from the ICI-report in three parts: The innovations in urodynamic techniques ''in general,'' the test characteristics and normal values of urodynamic studies (UDS) as well as the asse...

show abstract

“…However, a substantial number of these patients have disappointing results and coupled with reluctance to avoid surgery. These patients eventually present as CUR at a later stage thus a advanced age group presentation with CUR is observed [13,[16][17][18][19][20][21][22][23][24][25][26][27]. …”

Section: Discussionmentioning

confidence: 99%

Does Temporary Catheter Drainage of Urine Improves Detrusor Function in Chronic Urinary Retention in Patients with Bladder Outlet Obstruction.

Pal¹

2017

UNOAJ

View full text Add to dashboard Cite

Chronic urinary retention (CUR) is one of the consequences of bladder outlet obstruction (BOO) that occurs due to impaired functions of detrusor muscles secondary to obstruction related changes in the bladder wall. The effect of catheter drainage (CD) on detrusor function in CUR in animals is well studied but in humans there are very few studies to see its effect in CUR. Material and methods:This is a non-randomized, retrospective study wherein case records of 50 eligible patients attending the Department of Urology during January 2010 to March 2012 were evaluated for CUR. Two UDS, performed 6-12 weeks (average 9 weeks) apart and the parameters which were evaluated were bladder sensation, capacity and voiding detrusor pressure. These parameters were also evaluated against the age of the patient, duration of symptoms and the amount of urine drained on catheterization. Results:The commonest symptoms observed were decrease flows of urine, frequency, straining and incomplete emptying. Bladder function improvement after CD was observed to be maximum in patients with following characteristics: age at presentation in the range of > 60 to < 70 years, duration of lower urinary tract symptoms (LUTS) less than 5 years and amount of urine drained at the time of catheterization being < 500 ml. Conclusion:CUR secondary to BOO is a common problem in elderly males. UDS is the "gold standard" for its evaluation and helps to plan further management. CD of urine is an effective mode of temporary management in patients of CUR secondary to BOO as it provides rest to the detrusor muscle in humans.

show abstract

Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients

Cited by 262 publications

References 22 publications

Urodynamics in women from menopause to oldest age: what motive? what diagnosis?

Urodynamics in women from menopause to oldest age: what motive? what diagnosis?

Does Temporary Catheter Drainage of Urine Improves Detrusor Function in Chronic Urinary Retention in Patients with Bladder Outlet Obstruction.

Contact Info

Product

Resources

About