Detrusor underactivity versus bladder outlet obstruction clinical and urodynamic factors

Kalil, Jefferson; D’Ancona, Carlos Arturo Levi

doi:10.1590/s1677-5538.ibju.2019.0402

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…Although it was rarely demonstrated in literatures, some of the DU patients in clinical practice were young or mid-age, neurologically intact, without obviously anatomical obstruction, surgical or systemic medical disease history. Some researchers refer to these patients as idiopathic DU [ 3 ], and the video-urodynamic study of idiopathic DU may exhibit non-relaxation bladder neck or external urethral sphincter with low detrusor pressure [ 93 94 ]. A hypothesis suggests the mechanism of idiopathic DU might be resulted from high sympathetic activity inhibition in detrusor reflex contraction, which the inhibition had been well demonstrated in early animal studies [ 95 ].…”

Section: H Uman Sympathetic Inhibitory Detrusor Underactivitymentioning

confidence: 99%

Pathogenesis evidence from human and animal models of detrusor underactivity

et al. 2022

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A BSTRACT Detrusor underactivity (DU) is a common urodynamic diagnosis in patients with lower urinary tract symptoms and large post-voiding residual volume. Animal and human studies showed the possible etiologies of DU include central or peripheral nerve injury, bladder outlet obstruction, chronic ischemia, aging, diabetes mellitus, and sympathetic inhibition of micturition reflex. Evidence from animal and human DU studies with various etiologies revealed highly similar gross and histological characteristics in the bladders, including increased bladder weight, bladder wall thickening, inflammation, collagen deposition, and fibrosis. In electron microscopy, smooth muscle destruction, swollen mitochondria, decreased nerve innervation, caveolae, and umbrella cell fusiform vesicles were noted in the DU bladders. Most animal DU models demonstrate detrusor contractility changes from compensatory to the decompensatory stage, and the change was compatible with human DU observation. The cystometry in the DU animal studies is characterized by impaired contractility, prolong intercontraction interval, and hyposensation, while in vitro bladder muscle strips experiment may exhibit normal detrusor contractility. Decreased bladder blood flow and increased oxidative stress in bladders had been proved in different animal DU models, suggesting they should be important in the DU pathogenesis pathway. Sensory receptors mRNA and protein expression changes in DU bladders had been observed in both animal and human studies, including muscarinic receptors M2, M3, adrenergic receptor β3, purinergic receptor P2X1, P2X3, and transient receptor potential vanilloid (TRPV) 1 and TRPV4. Although some of the sensory receptors changes remain controversial, it might be the target for further pharmacologic treatments.

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Section: H Uman Sympathetic Inhibitory Detrusor Underactivitymentioning

confidence: 99%

Pathogenesis evidence from human and animal models of detrusor underactivity

et al. 2022

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“…Because DU and BOO have common symptoms, UDS is considered as the accepted method for the precise diagnosis of DU and BOO [ 31 ]. Nevertheless, uroflowmetry study is insufficient to differentiate between DU alone, BOO alone and BOO with DU although a study by Wada et al stated that patients with DU alone have a higher incidence of sawtooth uroflowmetry pattern than BOO [ 32 ], and lower intravesical prostatic protrusion and BVE are also predictive factors for DU [ 33 ].…”

Section: Diagnosis and Evaluation (Shown In Table 1 )mentioning

confidence: 99%

“…The results showed DWT ≦ 1.23 mm and >445 mL bladder capacity presented a higher possibility of DU. In contrast, Kalil et al [ 31 ] pointed out that clinical variables including the International Prostate Symptom Score (IPSS) and PVR are not enough to differentiate patients with DU from those with BOO, and they suggest the need for combined UDS parameters for accurate diagnosis.…”

Section: Diagnosis and Evaluation (Shown In Table 1 )mentioning

confidence: 99%

Detrusor Underactivity in Men with Bladder Outlet Obstruction

2022

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Detrusor underactivity (DU) and bladder outlet obstruction (BOO) are both common troublesome causes of lower urinary tract symptoms (LUTS) and often impact on quality of life simultaneously in men. This article aims to focus on DU with BOO in male patients. Methods: Original articles concerning DU with BOO were identified through literature research from PubMed and EMBASE database. We selected 38 articles in our review, including those concerning pathophysiology, evaluation, treatment and predictors for a successful BOO surgery for DU. Results: DU from BOO can result from several pathophysiological mechanisms. Although urodynamic study (UDS) is considered as a precise method to diagnose DU and BOO, there are some previous studies which proposed a non-invasive method to identify DU related to BOO. The treatment goal of DU is restoring bladder contractility using medication or surgery. Releasing outlet obstruction and resistance is the main strategy to restore bladder contractility when medication to directly increase bladder contractility has had limited efficacy. Conclusions: DU from BOO is poorly understood and is largely under-researched. The etiology and pathophysiology still need to be evaluated. Effective and safe medication to restore bladder contractility is also lacking. It remains valuable to perform further research to reveal the unknown aspects of DU.

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“…The main factors complicating treatment are high postvoid residual volumes, recurrent urinary infections, formation of urinary tract stones and even acute insufficiency that can progress to chronic kidney disease [ 4 – 7 ]. Therefore, it is necessary to develop new therapies, as clean intermittent catheterization physical therapy and clinical follow-up can only be used to treat the complications of the disease but do not restore the contractile capacity of the bladder.…”

Section: Introductionmentioning

confidence: 99%

Autologous adipose-derived mesenchymal stem cell therapy reverses detrusor underactivity: open clinical trial

et al. 2023

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Background Detrusor underactivity is a disease that can cause chronic urinary tract infection, urinary tract infection, urinary retention and kidney failure and has no effective treatment in traditional medicine. The present research evaluated the effects of cell therapy with adipose tissue-derived stem cells on the treatment of detrusor underactivity in men. Methods Nine male patients diagnosed with a clinical and urodynamic diagnosis of detrusor underactivity were evaluated and underwent two transplants via cystourethroscopy, with 2 × 106 cells/transplant, performed by intravesical injection at five points on the bladder body above the vesical trigone. Results Cell therapy increased the maximum flow from 7.22 ± 1.58 to 13.56 ± 1.17, increased the mean flow from 3.44 ± 0.74 to 5.89 ± 0.45, increased the urinated volume from 183.67 ± 49.28 to 304.78 ± 40.42 and reduced the residual volume in the uroflowmetry exam from 420.00 ± 191.41 to 118.33 ± 85.51; all of these changes were significant (p < 0.05). There were also significant increases (p < 0.05) in maximum flow (from 7.78 ± 0.76 to 11.56 ± 1.67), maximum detrusor pressure (from 20.22 ± 8.29 to 41.56 ± 5.75), urinary volume (from 244 ± 27.6 to 418.89 ± 32.73) and bladder contractility index (from 44.33 ± 4.85 to 100.56 ± 8.89) in the pressure flow study. Scores on the International Consultation on Incontinence Questionnaire decreased from 11.44 ± 1.43 to 3.78 ± 0.78 after cell therapy, which indicates an improvement in quality of life and a return to daily activities. No complications were observed in the 6-month follow-up after cell therapy. Before treatment, all patients performed approximately five intermittent clean catheterizations daily. After cell therapy, 7/9 patients (77.78%) did not need catheterizations, and the number of catheterizations for 2/9 patients (22.28%) was reduced to two catheterizations/day. Conclusions The results indicate that stem cell therapy led to improvements in voiding function. Cell therapy with adipose tissue-derived stem cells is safe and should be considered a new therapeutic option for the treatment of detrusor underactivity. Trial registration ISRCTN, ISRCTN23909398; Registered 15 March 2021—Retrospectively registered, https://doi.org/10.1186/ISRCTN23909398

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Detrusor underactivity versus bladder outlet obstruction clinical and urodynamic factors

Cited by 7 publications

References 21 publications

Pathogenesis evidence from human and animal models of detrusor underactivity

Pathogenesis evidence from human and animal models of detrusor underactivity

Detrusor Underactivity in Men with Bladder Outlet Obstruction

Autologous adipose-derived mesenchymal stem cell therapy reverses detrusor underactivity: open clinical trial

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