Detrusor underactivity in women: A current understanding

Hartigan, Siobhán M.; Reynolds, W. Stuart; Dmochowski, Roger R.

doi:10.1002/nau.24147

Cited by 13 publications

(9 citation statements)

References 48 publications

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“…This is a simple, but profoundly startling, observation that may influence understanding of the contractile function of the bladder during voiding after further study. There is increasing appreciation for the role of impaired bladder contractility and its effects on treatment outcomes [20][21][22][23][24]. All of the men with BPH/LUTS in this study exhibited decreased bladder contractility on traditional multichannel urodynamic evaluation (data not shown).…”

Section: Discussionmentioning

confidence: 72%

A pilot study of bladder voiding with real-time MRI and computational fluid dynamics

et al. 2020

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Lower urinary track symptoms (LUTS) affect many older adults. Multi-channel urodynamic studies provide information about bladder pressure and urinary flow but offer little insight into changes in bladder anatomy and detrusor muscle function. Here we present a novel method for real time MRI during bladder voiding. This was performed in a small cohort of healthy men and men with benign prostatic hyperplasia and lower urinary tract symptoms (BPH/LUTS) to demonstrate proof of principle; The MRI urodynamic protocol was successfully implemented, and bladder wall displacement and urine flow dynamics were calculated. Displacement analysis on healthy controls showed the greatest bladder wall displacement in the dome of the bladder while men with BPH/LUTS exhibited decreased and asymmetric bladder wall motion. Computational fluid dynamics of voiding showed men with BPH/LUTS had larger recirculation regions in the bladder. This study demonstrates the feasibility of performing MRI voiding studies and their potential to provide new insight into lower urinary tract function in health and disease.

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Section: Discussionmentioning

confidence: 72%

A pilot study of bladder voiding with real-time MRI and computational fluid dynamics

et al. 2020

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“…Another study demonstrated that bethanechol reduced the bladder sensory threshold in women with DUA 8 . Given the questionable efficacy of parasympathomimetic agents in treating DUA and dose‐dependent systemic adverse events, including fatal overdose, the use of those drugs is limited 28 . This study found that parasympathomimetics showed no beneficial effects on achieving catheter‐free status.…”

Section: Discussionmentioning

confidence: 77%

Predictive factors for the success of trial catheter removal for women with urinary retention

Takanashi

Ito

Fukazawa

et al. 2022

LUTS

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Objective: To investigate the outcome, determine the predictors for the success of, and evaluate the efficacy of pharmacokinetic therapy on trial catheter removal for women with urinary retention.Methods: Inclusion criteria were female patients with acute urinary retention defined as painful, palpable, or percussive bladder, when the patient is unable to pass any urine, accompanied by postvoid residual (PVR) > 250 ml, and who underwent trial catheter removal between July 2009 and July 2019. Before trial catheter removal, alpha-blockers alone or alpha-blockers and parasympathomimetics (bethanechol or distigmine bromide) were used to facilitate spontaneous voiding in some cases.Results: Fifty-nine of 104 (56.7%) women with urinary retention were catheterfree post trial. There was no significant difference between successful and nonsuccessful trials in average age (p = .392), median ECOG (Eastern Cooperative Oncology Group) performance status (p = .374), diabetes mellitus (p = .842), dementia (p = .801), previous history of cerebrovascular events (p = .592), or intrapelvic surgery (p = .800). Oral medications were administered for 39/59 (66.1%) in the success group and 30/45 (66.7%) patients in the non-success groups (p = .598).Serum albumin (3.2 ± 0.7 g/dl and 2.8 ± 0.8 g/dl, p = .039) and total protein values (6.5 ± 0.8 g/dl and 6.0 ± 1.0 g/dl, p = .038) at diagnosis of urinary retention were higher in the success group than the non-success group, respectively. Multivariate logistic regression found that a serum albumin >3 g/dl was an independent predictor of successful trial catheter removal for women with urinary retention (p = .030, odds ratio [OR] 3.3, 95% confidence interval [CI] of OR 1.1-9.9). Age < 70 years old was a likely predictor of successful trial catheter removal (p = .066, OR 4.8, 95% CI of OR 0.9-25.0).Conclusions: This is the first retrospective study to investigate the predictive factors for successful trial catheter removal in women with urinary retention. A serum albumin value >3 mg/dl at diagnosis of urinary retention was a significant independent predictor of catheter-free status after trial catheter removal, and age < 70 years-old was a possible contributor. There was no evidence that oral medication contributed to catheter-free status.

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“…In patients with nonneurogenic LUTS referred for urodynamic evaluation, DU is present in 9%–28% of men <50 years of age, increasing to as much as 48% in men >70 years. In elderly women, prevalence ranged from 12% to 45% 5,6 . UAB is likely to be more prevalent than recognized and is undertreated.…”

Section: Introductionmentioning

confidence: 99%

“…In elderly women, prevalence ranged from 12% to 45%. 5,6 UAB is likely to be more prevalent than recognized and is undertreated. Although some patients benefit from sacral neuromodulation to improve detrusor function, UAB is generally incurable with management mostly focused on effective strategies for bladder drainage, such as clean intermittent selfcatheterization (CIC), which is a considerable burden to patients.…”

Section: Introductionmentioning

confidence: 99%

“…Although some patients benefit from sacral neuromodulation to improve detrusor function, UAB is generally incurable with management mostly focused on effective strategies for bladder drainage, such as clean intermittent selfcatheterization (CIC), which is a considerable burden to patients. 6 ASP8302 is a novel positive allosteric modulator for the muscarinic M3 receptor (M3-PAM), hypothesized to enhance activation of the receptor only when it is stimulated by its endogenous ligand acetylcholine during the voiding phase of micturition, while being relatively inactive during the storage phase. This increases the therapeutic window with presumably fewer side effects than existing cholinergic agents.…”

Section: Introductionmentioning

confidence: 99%

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Muscarinic‐3‐receptor positive allosteric modulator ASP8302 in patients with underactive bladder. A randomized controlled trial

Till

Arita

Kuroishi

et al. 2022

Neurourology and Urodynamics

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The aim of this study is to evaluate safety and efficacy of ASP8302, a novel positive allosteric modulator for the muscarinic M3 receptor (M3-PAM), in patients with underactive bladder (UAB). Methods: A randomized, double-blind, placebo-controlled multicenter study was performed in adult male/female subjects with UAB, defined as incomplete bladder emptying (postvoid residual volume [PVR] > 100 ml) without significant bladder outlet obstruction and/or overactive bladder. Subjects were randomized (1:1) to receive 4-week oral once-daily administration of 100 mg ASP8302 or matching placebo. Primary endpoint was a change from baseline in PVR measured by catheterization after standardized bladder filling (PVR C2 ). Other endpoints included PVR and bladder voiding efficiency (BVE) measured in various ways, uroflowmetry, bladder diary, and questionnaires. Pressureflow studies were performed in a subgroup.Results: One hundred and thirty-five patients were randomized (ASP8302 group: 65 patients, placebo group: 70 patients). The median change in PVR C2 was −40.0 ml (ASP8302) versus −35.0 ml (placebo) and the difference between groups was −5.0 ml (p = 0.960). In males, functional and symptomatic outcomes improved, for example, maximum urine flow rate (Q max ) and detrusor pressure at Q max (P det.Qmax ) increased (mean difference in change ASP8302 vs. placebo: 3.8 ml/s, p = 0.031 and 12.7 cm H 2 O, p = 0.034, respectively). Urinary incontinence episodes/24 h decreased in males with preexisting incontinence (mean difference: −0.35; p = 0.028). The incidence of adverse events was similar between study groups (ASP8302: 33.3%, placebo: 31.4%). In the included subjects, both baseline urine flow and bladder voiding pressure was low. Compared with PVR, simultaneous BVE measurements were more consistent between various methods (spontaneous vs. standardized bladder filling, catheterization vs. ultrasound [US]).

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Detrusor underactivity in women: A current understanding

Cited by 13 publications

References 48 publications

A pilot study of bladder voiding with real-time MRI and computational fluid dynamics

A pilot study of bladder voiding with real-time MRI and computational fluid dynamics

Predictive factors for the success of trial catheter removal for women with urinary retention

Muscarinic‐3‐receptor positive allosteric modulator ASP8302 in patients with underactive bladder. A randomized controlled trial

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