Detrusor underactivity versus bladder outlet obstruction clinical and urodynamic factors

Kalil, Jefferson; D’Ancona, Carlos Arturo Levi

doi:10.1590/s1677-5538.ibju.2019.0402

Cited by 9 publications

(6 citation statements)

References 21 publications

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“…Because DU and BOO have common symptoms, UDS is considered as the accepted method for the precise diagnosis of DU and BOO [ 31 ]. Nevertheless, uroflowmetry study is insufficient to differentiate between DU alone, BOO alone and BOO with DU although a study by Wada et al stated that patients with DU alone have a higher incidence of sawtooth uroflowmetry pattern than BOO [ 32 ], and lower intravesical prostatic protrusion and BVE are also predictive factors for DU [ 33 ].…”

Section: Diagnosis and Evaluation (Shown In Table 1 )mentioning

confidence: 99%

“…The results showed DWT ≦ 1.23 mm and >445 mL bladder capacity presented a higher possibility of DU. In contrast, Kalil et al [ 31 ] pointed out that clinical variables including the International Prostate Symptom Score (IPSS) and PVR are not enough to differentiate patients with DU from those with BOO, and they suggest the need for combined UDS parameters for accurate diagnosis.…”

Section: Diagnosis and Evaluation (Shown In Table 1 )mentioning

confidence: 99%

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Detrusor Underactivity in Men with Bladder Outlet Obstruction

2022

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Detrusor underactivity (DU) and bladder outlet obstruction (BOO) are both common troublesome causes of lower urinary tract symptoms (LUTS) and often impact on quality of life simultaneously in men. This article aims to focus on DU with BOO in male patients. Methods: Original articles concerning DU with BOO were identified through literature research from PubMed and EMBASE database. We selected 38 articles in our review, including those concerning pathophysiology, evaluation, treatment and predictors for a successful BOO surgery for DU. Results: DU from BOO can result from several pathophysiological mechanisms. Although urodynamic study (UDS) is considered as a precise method to diagnose DU and BOO, there are some previous studies which proposed a non-invasive method to identify DU related to BOO. The treatment goal of DU is restoring bladder contractility using medication or surgery. Releasing outlet obstruction and resistance is the main strategy to restore bladder contractility when medication to directly increase bladder contractility has had limited efficacy. Conclusions: DU from BOO is poorly understood and is largely under-researched. The etiology and pathophysiology still need to be evaluated. Effective and safe medication to restore bladder contractility is also lacking. It remains valuable to perform further research to reveal the unknown aspects of DU.

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Section: Diagnosis and Evaluation (Shown In Table 1 )mentioning

confidence: 99%

Section: Diagnosis and Evaluation (Shown In Table 1 )mentioning

confidence: 99%

Detrusor Underactivity in Men with Bladder Outlet Obstruction

2022

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“…Although it was rarely demonstrated in literatures, some of the DU patients in clinical practice were young or mid-age, neurologically intact, without obviously anatomical obstruction, surgical or systemic medical disease history. Some researchers refer to these patients as idiopathic DU [ 3 ], and the video-urodynamic study of idiopathic DU may exhibit non-relaxation bladder neck or external urethral sphincter with low detrusor pressure [ 93 94 ]. A hypothesis suggests the mechanism of idiopathic DU might be resulted from high sympathetic activity inhibition in detrusor reflex contraction, which the inhibition had been well demonstrated in early animal studies [ 95 ].…”

Section: H Uman Sympathetic Inhibitory Detrusor Underactivitymentioning

confidence: 99%

Pathogenesis evidence from human and animal models of detrusor underactivity

Kuo

Jhang

Jiang

et al. 2022

Tzu Chi Medical Journal

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A BSTRACT Detrusor underactivity (DU) is a common urodynamic diagnosis in patients with lower urinary tract symptoms and large post-voiding residual volume. Animal and human studies showed the possible etiologies of DU include central or peripheral nerve injury, bladder outlet obstruction, chronic ischemia, aging, diabetes mellitus, and sympathetic inhibition of micturition reflex. Evidence from animal and human DU studies with various etiologies revealed highly similar gross and histological characteristics in the bladders, including increased bladder weight, bladder wall thickening, inflammation, collagen deposition, and fibrosis. In electron microscopy, smooth muscle destruction, swollen mitochondria, decreased nerve innervation, caveolae, and umbrella cell fusiform vesicles were noted in the DU bladders. Most animal DU models demonstrate detrusor contractility changes from compensatory to the decompensatory stage, and the change was compatible with human DU observation. The cystometry in the DU animal studies is characterized by impaired contractility, prolong intercontraction interval, and hyposensation, while in vitro bladder muscle strips experiment may exhibit normal detrusor contractility. Decreased bladder blood flow and increased oxidative stress in bladders had been proved in different animal DU models, suggesting they should be important in the DU pathogenesis pathway. Sensory receptors mRNA and protein expression changes in DU bladders had been observed in both animal and human studies, including muscarinic receptors M2, M3, adrenergic receptor β3, purinergic receptor P2X1, P2X3, and transient receptor potential vanilloid (TRPV) 1 and TRPV4. Although some of the sensory receptors changes remain controversial, it might be the target for further pharmacologic treatments.

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“…Some researchers relied solely on medical history and identified symptoms such as decreased urinary stream, hesitancy or urgency as potential indicators of BOO, when differentiating from DU [7]. Others incorporated noninvasive UFL parameters, such as UFL curve shapes or PVR Ratio, along with symptoms and questionnaires to construct a prediction nomogram [8][9][10]. Nevertheless, definitive set of factors distinguishing DU from BOO remain elusive, which imposes the need for further development of noninvasive diagnostic method [1].…”

Section: Introductionmentioning

confidence: 99%

(A)voiding misdiagnosis: prediction of detrusor underactivity vs. bladder outlet obstruction using pre-urodynamic nomogram in male patients with LUTS

Garbas,

Zapała,

Ślusarczyk

et al. 2024

Int Urol Nephrol

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Purpose Our study aimed to develop a noninvasive model using a combination of the set of clinical data and uroflowmetry (UFL) to differentiate between detrusor underactivity (DU) and bladder outlet obstruction (BOO) in non-neurogenic male patients with lower urinary tract symptoms (LUTS). Methods Data from 229 men with LUTS, diagnosed with DU or BOO on a pressure-flow study (PFS), were retrospectively analyzed, including medical history, Core Lower Urinary Tract Symptoms score (CLSS) questionnaire, UFL and PFS. Uni- and multivariate logistic regression were utilized for the prediction analyses. Results Of the cohort, 128 (55.9%) patients were diagnosed with DU. A multivariate logistic regression analysis identified less prevalent nocturia (OR 0.27, p < 0.002), more prevalent intermittency (OR 2.33, p = 0.03), less prevalent weak stream (OR 0.14, p = 0.0004), lower straining points in CLSS (OR 0.67, p = 0.02), higher slow stream points in CLSS (OR 1.81, p = 0.002), higher incomplete emptying points in CLSS (OR 1.31, p < 0.02), lower PVR ratio (OR 0.20, p = 0.03), and present features of fluctuating (OR 2.00, p = 0.05), fluctuating-intermittent (OR 3.09, p < 0.006), and intermittent (OR 8.11, p = 0.076) UFL curve shapes as independent predictors of DU. The above prediction model demonstrated satisfactory accuracy (c-index of 0.783). Conclusion Our 10-factor model provides a noninvasive approach to differentiate DU from BOO in male patients with non-neurogenic LUTS, offering a valuable alternative to invasive PFS.

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Detrusor underactivity versus bladder outlet obstruction clinical and urodynamic factors

Cited by 9 publications

References 21 publications

Detrusor Underactivity in Men with Bladder Outlet Obstruction

Detrusor Underactivity in Men with Bladder Outlet Obstruction

Pathogenesis evidence from human and animal models of detrusor underactivity

(A)voiding misdiagnosis: prediction of detrusor underactivity vs. bladder outlet obstruction using pre-urodynamic nomogram in male patients with LUTS

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