Detrusor Underactivity and the Underactive Bladder: A Systematic Review of Preclinical and Clinical Studies

Osman, Nadir I.; Esperto, Francesco; Chapple, Christopher R.

doi:10.1016/j.eururo.2018.07.037

Cited by 76 publications

(86 citation statements)

References 46 publications

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“…Moreover, the nomogram has a good calibration and an excellent DCA with a net benefit in the range of probabilities between 10% and 80%. In our cohort, 43% of the patients presented DUA (defined as BCI < 100 mm H 2 0) which is in line with the peer‐reviewed literature on DUA in patients with LUTS 1 . In our study, we observed a statistically significant median difference of 0.9 mm in BWT values between patients with BCI < 100 and BCI > 100.…”

Section: Discussionsupporting

confidence: 89%

“…Detrusor underactivity (DUA) was defined in 2002 by the International Continence Society on the basis of urodynamic testing as “a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span.” 1 Review of the literature on the prevalence of DUA in patients with non‐neurogenic lower urinary tract symptoms (LUTS) undergoing urodynamic studies suggests that in younger men (aged < 50 years), DUA prevalence is 9% to 28%, which rises to 48% in elderly men (aged > 70 years) 2 …”

Section: Introductionmentioning

confidence: 99%

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The role of bladder wall thickness in the evaluation of detrusor underactivity: Development of a clinical nomogram

Nunzio

Lombardo

Cicione

et al. 2020

Neurourology and Urodynamics

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Aims: The aim of our study was to investigate noninvasive predictors for detrusor underactivity (DUA) in male patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE).Methods: A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment including International Prostatic Symptoms Sco re, uroflowmetry, urodynamic studies (cystometry and pressure-flow studies), transrectal ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BWT). Logistic regression analysis was used to investigate predictors of DUA, defined as a bladder contractility index < 100 mm H 2 O. A nomogram was developed based on the multivariable logistic regression model. Results: Overall 448 patients with a mean age of 66 ± 11 years were enrolled.In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 0.50 per mm; 95% confidence interval [CI], 0.30-0-66; P = .001) andQmax (OR: 0.75 per mL/s; 95% CI, 0.70-0.81; P = .001) were significant predictors for DUA. The nomogram based on the model presented good discrimination (area under the curve [AUC]: 0.82), good calibration (Hosmer-Lemeshow test, P > .05) and a net benefit in the range of probabilities between 10% and 80%. Conclusions: According to our results, BWT and Qmax can noninvasively predict the presence of DUA in patients with LUTS and BPE. Although our study should be confirmed in a larger prospective cohort, we present the first available nomogram for the prediction of DUA in patients with LUTS. K E Y W O R D S bladder wall thickness, detrusor underactivity, lower urinary tract symptoms, pressure flow studies 1116 | DE NUNZIO ET AL. Residual urine 40 (0/80); 64.5 ± 96.4 Urodynamic Qmax, mL/s 8 (7/12); 9.2 ± 5.3 PdetQmax, cm H 2 O 50 (36/71); 57 ± 28 Shaffer Class 2 (1/3); 2.3 ± 1.5 Bladder contractility index 105 (83/130); 108 ± 33 Bladder outlet obstruction index 32 (13/56); 36 ± 32 Note: Data are presented as median (IQR); mean ± SD. Abbreviations: BWT, bladder wall thickness; I-PSS, International Prostate Symptom Score; IQR, interquartile range; PdetQmax, pressure at maximum flow rate; Qmax, maximum flow rate. DE NUNZIO ET AL. | 1117 5 | CONCLUSION Our nomogram including BWT and Qmax shows good discrimination, calibration, and clinical benefit for the diagnosis of DUA. After external validation, the implementation of our nomogram could improve the management/counseling of patients with LUTS/BPH.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The role of bladder wall thickness in the evaluation of detrusor underactivity: Development of a clinical nomogram

Nunzio

Lombardo

Cicione

et al. 2020

Neurourology and Urodynamics

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“…In addition, pre‐Pdet at Qmax was ≤40 cmH 2 O in four of six patients. Although the definition of UAB remains under consideration and its establishment is a further challenge, the results of the present study might lead to a possible definition of UAB …”

mentioning

confidence: 92%

“…UAB is a symptom‐based pathology characterized by contraction disorder at voiding and difficult urination leading to various voiding‐related symptoms . The lack of effective pharmacological options for UAB poses a significant medical challenge.…”

mentioning

confidence: 99%

Efficacy of acotiamide hydrochloride hydrate added to α‐blocker plus cholinergic drug combination therapy

Sugimoto

Akiyama²,

Matsumura

et al. 2019

Int J of Urology

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“…The ICS definition of DUA is limited by the ambiguity of what constitutes a reduced contraction strength or length of prolonged voiding. 4 While the prevalence of DUA among women in the United States is not precisely known, 5 clinical studies have found DUA to be very common in patients with LUTS referred for UDS, especially in older age groups. 4 A population-based study in Detroit found nearly a quarter of survey respondents reported difficulty emptying their bladder.…”

Section: Definitions and Diagnosismentioning

confidence: 99%

Detrusor underactivity in women: A current understanding

Hartigan

Reynolds

Dmochowski

2019

Neurourology and Urodynamics

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Aims To examine the current understanding and management of detrusor underactivity (DUA) and underactive bladder (UAB) in women. Methods A review of the current literature was performed with a specific focus on new management strategies and treatment options for women with DUA and UAB. Results DUA has become an area of increased interest in recent years. Affecting up to 45% of older women undergoing urodynamic evaluation for non‐neurogenic lower urinary tract symptoms, DUA is common. There are a variety of possible etiologies including neurogenic or myogenic dysfunction. As there is currently no cure for DUA and no way to restore the ability of the detrusor muscle to contract, management of DUA in women is mostly focused on effective bladder drainage by urinary catheterization. Clean intermittent catheterization is the gold standard for bladder drainage however for a variety of reasons, women with DUA often are managed with indwelling urethral catheter or suprapubic tube. Medications, sacral neuromodulation, and the inFlow urinary prosthesis are also treatment alternatives or additions to catheterization. Novel therapies using stem cells and gene therapy are also under investigation for the treatment of DUA and UAB. Conclusions DUA is likely more prevalent than recognized and undertreated in women. It is vital that further research in treatment options beyond catheterization be developed for these patients to offer patients a variety of treatment options.

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Detrusor Underactivity and the Underactive Bladder: A Systematic Review of Preclinical and Clinical Studies

Cited by 76 publications

References 46 publications

The role of bladder wall thickness in the evaluation of detrusor underactivity: Development of a clinical nomogram

The role of bladder wall thickness in the evaluation of detrusor underactivity: Development of a clinical nomogram

Efficacy of acotiamide hydrochloride hydrate added to α‐blocker plus cholinergic drug combination therapy

Detrusor underactivity in women: A current understanding

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