Two types of detrusor underactivity in men with nonneurogenic lower urinary tract symptoms

Abstract

Aims: To clarify the clinical features of men with nonneurogenic detrusor underactivity (DU) by focusing on storage dysfunction (SD).Methods: We retrospectively reviewed the clinical and urodynamic data of men with nonneurogenic DU. Patients were divided into two groups according to the presence or absence of SD, such as detrusor overactivity (DO) and reduced bladder compliance (BC). Patient characteristics, lower urinary tract symptoms (LUTS), and urodynamic parameters were compared. DU was defined as bladder contractility index (BCI) ≤ 100 and bladder outlet obstruction index (BOOI) ≤ 40.Results: Of 212 men with DU, 123 (58.0%) had concomitant SD (SD + DU group), and 89 (42.0%) had only DU (DU-only group). Age, prostate volume, and severity of storage symptoms were significantly higher in the SD + DU group. Particularly, >80% of men in the SD + DU group met the diagnostic criteria for overactive bladder in Japan, which was significantly higher than the 26% of men in the DU-only group. The frequency of urinary urgency incontinence (UUI) was also significantly higher in the SD + DU group (65% vs. 12% in DU-only group). In contrast, voiding symptoms, including straining, were more severe in the DU-only group. Regarding the urodynamic parameters, compared to the DU-only group, bladder capacity was significantly smaller and BOOI and BCI were significantly higher in the SD + DU group. However, there was no significant difference in the maximum flow rate and bladder voiding efficiency.Conclusions: Approximately 60% of men with DU had SD, such as DO and/or reduced BC, whereas the remaining 40% had increased bladder capacity without an increase in detrusor pressure during the storage phase. There were significant differences in the storage and voiding symptoms between the groups. It is important to divide patients with DU based on SD to accurately clarify the clinical picture of DU.

Underactive Bladder and Detrusor Underactivity: New Advances and Prospectives

“…Significant parameters between patients with DU and those with BOO were older age (≥74 years old), smaller prostate volume (PV ≤ 34.8), and a lower acute symptom score (IPSS Q4 ≤ 1) [85]. It has also been suggested that DU should be categorized according to the presence or absence of storage phase symptoms, as the proportion of patients with DU combined with storage phase symptoms has been found to be higher in terms of age, prostate volume, and urinary incontinence than that of patients with DU alone [81]. Kim Researchers have widely discussed describing detrusor muscle thickness (DMT) for the diagnosis of DU.…”

Liposomal Neostigmine Bromide: A Localized Therapeutic Approach for Detrusor Underactivity

“…[3] On account of the serious impacts on patients' quality of life caused by DUA and its high incidence around the world, [4] the pathogenesis, diagnosis, and treatment of DUA have aroused extensive attention. [1,5] With the continuous development of nanotechnology, nanodrug has been widely used in basic research and clinical application of multiple diseases, such as cancer, Alzheimer's disease, pneumonia, et al [6] Generally, nanodrug delivery system refers to particles with an average particle size of <100 nm or materials exhibiting nanoparticle properties having sizes of 100-1000 nm, [7] and currently, a variety of nanoscale drug delivery systems have been explored and developed, including microspheres, nanoemulsions, micelles, liposomes (LP), mesoporous inorganic nanoparticles, et al [8] The characteristics of nanodrug delivery systems contain: 1) improvement of drug stability and solubility; [9] 2) prolonging half life and enhancing targeting of the drugs; [10] 3) controlled and sustained release of drug; [11] and 4) enhancement in crossing biological barriers and improvement in administration of drugs. [12] This study aims to evaluate the therapeutic potential of cationic liposomal neostigmine bromide (NB), a novel drug delivery system, for the treatment of detrusor underactivity.…”

“…[ 3 ] On account of the serious impacts on patients’ quality of life caused by DUA and its high incidence around the world, [ 4 ] the pathogenesis, diagnosis, and treatment of DUA have aroused extensive attention. [ 1,5 ]…”