Management of Urinary Incontinence With Underactive Bladder: A Review

Abstract

Urinary incontinence is caused by storage function failure, while underactive bladder (UAB) is caused by a decline in detrusor contractility and voiding dysfunction. As the treatment mechanisms for incontinence and UAB are contrary to each other, it is difficult to treat both incontinence and UAB, and the patient’s quality of life can be further degraded. Conventional midurethral sling (MUS), such as transobturator tape or retropubic MUS, introduces a risk of postoperative voiding dysfunction in stress urinary incontinence with UAB. However, there have been several reports about the efficacy and safety of conventional MUS. Adjustable sling procedures, such as transobturator adjustable tape or the Remeex system, have better outcomes than conventional MUS because they control tension both during and after surgery. When voiding dysfunction occurs after incontinence treatment with UAB, voiding symptoms can be improved by various therapeutic modalities. Clean intermittent catheterization is recommended for patients with significant increased postvoid residual volumes or urinary retention. Although pharmacotherapy such as with alpha-blockers or parasympathomimetics can be considered for UAB, there is insufficient evidence of their effect on incontinence with UAB. Future therapies, such as stem cell therapy or gene therapy, may be used to treat incontinence with UAB. The possibility of management urgency urinary incontinence that related to detrusor hyperactivity with impaired contractility using sacral neuromodulation has been suggested. Further research is needed to establish evidence for the efficacy and safety of treatments for incontinence with UAB and improve patient quality of life.

Irreversible Bladder Remodeling Induced by Fibrosis

“…These findings suggest that contractile changes associated with bladder fibrosis constitute a complicated process that results in impaired bladder contractility with or without detrusor overactivity. Furthermore, the process of a coexistent voiding problem that is not associated with bladder fibrosis (e.g., stress urinary incontinence) can be a factor that induces incontinence [18][19][20]. Moreover, Uren et al [21] reported that patients diagnosed with DU using a urodynamic study showed nocturia, frequent daytime urination, urgency, and incontinence, as well as a weak urinary stream, hesitancy, and abdominal straining during urination.…”

Second-Line Surgical Management After Midurethral Sling Failure

“…The re-adjustable sling can be a better option for the patients who have a recurrent SUI with detrusor underactivity to avoid postoperative voiding difficulty [72]. When the revision is A c c e p t e d A r t i c l e planned for postoperative voiding difficulty, it should be noted that complete excision of the mesh can produce a higher incidence of SUI recurrence compared with partial excision or urethrolysis [65].…”

Incontinence in Patients With Underactive Bladder

“…In their article, "Management of Urinary Incontinence With Underactive Bladder: A Review" Cho and Kim [1] discuss different approaches to the management of urinary incontinence in patients with underactive bladder (UAB). As the authors point out, incontinence treatment requires that either the detrusor activity is decreased, which is the treatment principle in overactive bladder/detrusor overactivity, or that the bladder outlet resistance is increased, as is the basis for management of stress urinary incontinence (SUI) caused by e.g., intrinsic sphincter insufficiency or urethral hypermobility.…”

“…Continence is dependent on the interaction between the urethral sphincter and the detrusor, and since the functional importance of each of these components may vary, the therapeutic problem in the individual patient is to find a suitable balance between them. In patients with both SUI and DU, Cho and Kim [1] point out the advantages and high success rate of conventional midurethral and adjustable slings. In most studies cited, there were no differences between SUI patients with or without DU.…”

“…Due to the many factors involved, it has to be dealt with on an individual basis. The review by Cho and Kim [1] highlights how the disorder is currently managed, but also underlines the problems. Their plea for further research is strongly supported.…”