Underactive bladder in women

Abstract

Purpose of review Underactive bladder (UAB) is a clinical symptom complex only recently gaining recognition as a clinical diagnosis. Lack of consensus agreement on a definition of UAB has limited its recognition and diagnosis in clinical practice. The purposes of this review are to: present existing definitions of UAB, review recent data regarding clinical and urodynamic diagnosis of the condition, and examine up-to-date hypotheses regarding its pathophysiology, with a focus on women. Recent findings The process to develop a consensus definition for UAB as a clinical symptom complex is ongoing. Symptoms associated with UAB, such as weak stream, straining to void, and history of urinary retention are well correlated to detrusor underactivity on urodynamics, which frequently develops in elderly women. In addition to aging, UAB may be the end stage of a variety of contributing pathologic conditions such as diabetes and ischemic disease. In some women, UAB may result from a progression from overactive bladder to UAB. Summary Existing evidence supports UAB in women as a symptom complex with a clinical and pathophysiologic profile distinguishable from other lower urinary tract-associated clinical conditions. Consensus definitions of clinical and urodynamic diagnostic parameters will be essential to more widespread recognition of UAB.

Female underactive bladder – Current status and management

“…In a broad sense, impaired bladder emptying characteristic of UAB can arise from damage or malfunction of peripheral afferent, efferent, or central nervous system pathways, and detrusor myopathy. [ 3 ] Impaired afferent or sensory signaling, which is common with aging and diabetic cystopathy, can impair the micturition reflex leading to impaired emptying. [ 2 ] Impaired efferent or motor signaling due to peripheral nerve malfunction or injury can lead directly to impaired contractility.…”

“…[ 2 ] In men, UAB has traditionally been difficult to study because of the difficulty in distinguishing UAB from bladder outlet obstruction (BOO) without the usage of pressure flow studies. [ 3 ] However, it has been proposed that by studying the presence of DU and UAB in women, in whom BOO is rarely diagnosed, it might be possible to isolate the clinical symptomatology specific to UAB and continue to refine its clinical definition. [ 3 ] DU is a common entity occurring in up to 13.3% of elderly women with lower urinary tract symptoms (LUTS) with the prevalence of clinically diagnosed UAB certainly exceeding that number.…”

“…[ 3 ] However, it has been proposed that by studying the presence of DU and UAB in women, in whom BOO is rarely diagnosed, it might be possible to isolate the clinical symptomatology specific to UAB and continue to refine its clinical definition. [ 3 ] DU is a common entity occurring in up to 13.3% of elderly women with lower urinary tract symptoms (LUTS) with the prevalence of clinically diagnosed UAB certainly exceeding that number. [ 4 ] In recent years, UAB has been recognized as contributing significantly to LUTS in the elderly and interest in the topic has grown.…”

Phenotyping women with detrusor underactivity by presumed etiology: Is it plausible?

“…DU has been associated with neurologic, idiopathic, iatrogenic, and myogenic factors, which can result from common comorbid conditions . It has been identified in 12–45% of older women undergoing UDS for lower urinary tract symptoms . DU is also independently associated with increased age and is often cited as an indication for bladder catheterization in elderly, institutionalized patients …”

“…3 It has been identified in 12-45% of older women undergoing UDS for lower urinary tract symptoms. 3,5 DU is also independently associated with increased age and is often cited as an indication for bladder catheterization in elderly, institutionalized patients. 6 The aim of this study was to determine if clinical and urodynamic parameters differed between categories of presumed DU etiologies.…”