Is coexistent overactive–underactive bladder (with or without detrusor overactivity and underactivity) a real clinical syndrome? ICI‐RS 2019

Abstract

Aims Lower urinary tract symptoms (LUTS) can be classified into symptom syndromes based on which symptoms are predominant. Overactive bladder (OAB) syndrome, a storage dysfunction, and underactive bladder (UAB) syndrome, a voiding dysfunction, are common syndromes, which urodynamic tests may show to be caused by detrusor overactivity (DO) and detrusor underactivity (DU), but can also be associated with other urethro‐vesical dysfunctions. Sometimes OAB and UAB can coexist in the same patient and, if so, need a specific approach beyond treatment of the single and apparently opposing syndromes. Methods During its 2019 meeting in Bristol, the International Consultation on Incontinence Research Society held a literature review and expert consensus discussion focused on the emerging awareness of the coexisting overactive–underactive bladder (COUB). Results The consensus considered whether COUB is the combination of OAB and UAB syndromes, or a real unique clinical syndrome in the same patient, possibly with a common etiology. Definitions, pathophysiology, diagnosis, and treatment were discussed, and high‐priority research questions were identified. Conclusions COUB (with or without urodynamic evidence of DO and DU) may be considered a real clinical syndrome, because it differs from single OAB and UAB, and may not be the combination of both syndromes. Urodynamic tests may be necessary in unclear cases or in cases not responding to initial treatment of the most troublesome symptoms. It is pivotal to define the evolution of the syndrome and the characteristic population, and to recognize predictive or phenotyping factors to develop a specific approach and adequate outcome measures.

Urodynamic and clinical features in women with overactive bladder: When to suspect concomitant voiding dysfunction?

“…This chronic fatigue would lead to increased muscle thickening, alteration of muscle structure, progressive ischemia, inflammation, oxidative damage, fibrosis, and finally impaired contractility. 23 Using these nomograms and definitions we found that 23% of female patients with OAB had urodynamic voiding dysfunction (19.7% with BOO and 2.3% with DU). Applying different and more permissive definitions compared to our research, Cho et al analyzed 163 women with OAB.…”

Diagnostic Potential of Low Serum Platelet, Albumin and Prolong PT-INR for Overactive Bladder and Nocturia in Chronic Hepatitis-Related Liver Cirrhosis

“…Third, we only collect OABSS in these patients and the voiding diary, uroflowmery, and other urodynamic studies of them were lacking, so the voiding dysfunction of patients cannot be evaluated. [34] Third, selection bias may have been present as all patients were enrolled from our outpatient department and thus may present with liver cirrhosis of relatively minor severity. Nonetheless, LUTS-related quality of life is still an important consideration in patients with a Child-Pugh grade of A and B.…”

Treatment for overactive bladder

“…[ 13 ] Given its safety, low cost, ease of application, and potential to support self-administration, there is a clear impetus for further research to establish definitive evidence on the role of TTNS as second-line therapy, after lifestyle and behavioral changes have been implemented and as a direct alternative to pharmacological therapy in adults with OAB. [ 13 ] Nerve stimulations, such as sacral nerve stimulation, PTNS, and TTNS, deserve evaluation for patients with complicated lower urinary tract symptoms like the combination of OAB and underactive bladder, [ 31 ] despite further studies are needed.…”