Video-urodynamic characteristics of non-neurogenic, idiopathic underactive bladder in men – A comparison of men with normal tracing and bladder outlet obstruction

Abstract

ObjectiveUnderactive bladder is frequently encountered in elderly patients. It may result from detrusor underactivity (DU) or low detrusor contractility due to a urethral sphincter inhibitory effect. This study analyzed the video-urodynamic study (VUDS) characteristics of patients with underactive bladder in a large cohort of men with lower urinary tract symptoms (LUTS).MethodsMale patients with LUTS who had failed the initial treatment were consecutively enrolled. All patients underwent detailed urological investigations including prostate measurement, free uroflowmetry, post-void residual volume (PVR) measurement, cystoscopy and VUDS. The VUDS characteristics of the men with underactive bladder were analyzed and compared with those of men with bladder outlet obstruction and normal tracing.ResultsA total of 1329 men who underwent VUDS were included in this retrospective analysis. After VUDS, the final diagnosis was DU in 165 patients, poor relaxation of external sphincter (PRES) in 525, bladder outlet obstruction in 501, and normal tracing in 138. VUDS findings in DU patients showed a slowly increased detrusor pressure, intermittent detrusor contractions, or early decline of detrusor contraction, resulting in a low maximum flow rate (Qmax), and large PVR. In comparison with the PRES groups, DU patients were older, had reduced bladder sensation, lower detrusor pressure (Pdet), lower Qmax, larger PVR volume, and lower voiding efficiency. Patients with urodynamic PRES also had low-pressure–low-flow tracings, but their bladder sensation was similar to that with normal tracing. DU patients with very low Pdet also had low detrusor tonicity, and more medical co-morbidities than the other groups did.ConclusionIdiopathic underactive bladder in elderly men could be attributed to urodynamic DU and PRES. DU is associated with old age, reduced bladder sensation, low voiding efficiency, and medical co-morbidities.

The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction

“…The prevalence rates were 12-20% [87,89,90] and 17.6% [4] in male and female non-neurogenic VD refractory to medication patients, respectively. The incidence increased in young males [89] in patients with bladder pain syndrome [88] and in idiopathic DU patients [91]. Sphincteric BoNT-A injections might provide chemo-denervation of the EUS by inhibition of acetylcholine release in the neuromuscular junction to relieve the USD in PRES [23].…”

Therapeutic Effects of Botulinum Toxin A, via Urethral Sphincter Injection on Voiding Dysfunction Due to Different Bladder and Urethral Sphincter Dysfunctions

“…Voiding dysfunction may result from detrusor underactivity (DU), bladder outlet obstruction (BOO), urethral sphincter hyperactivity, or poor relaxation of the external urethral sphincter (PRES) during micturition. A previous urodynamic study reported DU in 12.4% of men [1] and in 23.1% of women [2] with voiding lower urinary tract symptoms (LUTS). Urethral sphincter hyperactivity was noted in 17.0% of women [3], and PRES in 39.5% of men [1] and 17.6% of women [3] with voiding dysfunction.…”

Can we improve our management of dysfunctional voiding in children and adults: International Consultation on Incontinence Research Society; ICI‐RS2018?

“…Repeated uroflows with EMG and postvoid residual urines are needed to verify the diagnosis in children . In adults, symptoms and noninvasive evaluation alone may not be able to diagnose or differentiate DV from other causes of VD . Although voiding symptoms or even urinary retention may be expected in DV patients, storage symptoms, usually due to detrusor overactivity, can be quite common and a significant proportion of patients present with mixed LUTS …”

“…12 Whatever the muscle involved that increases urethral resistance, it would lower the urine flow rate. Such variability of definition may explain the wide prevalence range reported among men (14%-43%) [13][14][15][16] and women with lower urinary tract symptoms (LUTS) (10.5%-34.6%). 12,17,18 Other researchers report a much lower prevalence of "learned VD" (2% of urodynamic investigations for LUTS in an adult population).…”

“…20,21 In adults, symptoms and noninvasive evaluation alone may not be able to diagnose or differentiate DV from other causes of VD. 9,11,14,15 Although voiding symptoms or even urinary retention may be expected in DV patients, storage symptoms, usually due to detrusor overactivity, can be quite common and a significant proportion of patients present with mixed LUTS. 11,12,17,22,23 Most researchers use video-urodynamic studies (UDS) with or without a surface perineal EMG to diagnose DV in adults, which is the most comprehensive method to meet the requirements of the ICS definition.…”