Impaired Detrusor Contractility in Community-Dwelling Elderly Presenting with Lower Urinary Tract Symptoms

Abarbanel, Joseph; Marcus, Esther‐Lee

doi:10.1016/j.urology.2006.11.019

Cited by 136 publications

(128 citation statements)

References 24 publications

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“…Hypocontractility was identified as a low detrusor pressure (less than 10 cm H 2 O) during the voiding phase, relative to the degree of obstruction, not resulting in (efficient) micturition. In case of a conventional-UDS, the hypocontractility definition is elaborated with a peak flow rate (Qmax) of less than 10 mL/s, voided volume should be greater than 100 mL and residual urine volume greater than 150 mL [14]. For ambulatory-UDS standardised limits have not yet been established [15].…”

Section: Urodynamic Studiesmentioning

confidence: 99%

The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation

et al. 2019

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Objectives: To assess the improvement of symptoms by sacral neuromodulation (SNM) in an objective way by carrying out an ambulatory urodynamic study (ambulatory-UDS). Until now, successful treatment has been defined as a ≥50% improvement recorded on voiding diaries. Voiding diaries are a patient reported outcome tool. A tool with less bias is desired to evaluate the treatment results before an expensive permanent system is implanted. Methods: Between 2002 and 2015, a total of 334 patients with lower urinary tract symptoms were included consecutively in an ambulatory-UDS database. From this database, a subgroup of patients was selected which underwent SNM. Results: In 51 patients, an ambulatory-UDS was performed both at baseline and during the SNM test period. A positive treatment outcome after test stimulation based on the patients’ voiding diary, correlated (p < 0.0001) with an improvement on ambulatory-UDS. Twenty-six of the 30 patients, who have showed improvement of more than 50% on voiding diary parameters and who had subjective improvement of their symptoms, showed an early improvement on ambulatory-UDS. Conclusions: Ambulatory-UDS can be used in clinical decision making, as it is associated with voiding diary improvement during the SNM test period. Using ambulatory-UDS to confirm success could in the future justify the shortening of the test period.

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Section: Urodynamic Studiesmentioning

confidence: 99%

The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation

et al. 2019

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“…Thus, impaired detrusor contraction is greater in women with a history of urinary retention (1). Symptoms of underactive bladder are common in both older men and women (7,61); however, its prevalence in people of Ͻ65 yr old is higher in women than men (20.6% vs. 9.3%) (61).…”

Section: 56)mentioning

confidence: 99%

Neuroanatomic and behavioral correlates of urinary dysfunction induced by vaginal distension in rats

Palacios-Galicia

Juárez

Morán

et al. 2016

American Journal of Physiology-Renal Physiology

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-The aim of the present study was to use a model of simulated human childbirth in rats to determine the damage to genitourinary structures and behavioral signs of urinary dysfunction induced by vaginal distension (VD) in female rats. In experiment 1, the length of the genitourinary tract and the nerves associated with it were measured immediately after simulated human delivery induced by VD or sham (SH) procedures. Electroneurograms of the dorsal nerve of the clitoris (DNC) were also recorded. In experiment 2, histological characteristics of the bladder and major pelvic ganglion of VD and SH rats were evaluated. In experiment 3, urinary parameters were determined in conscious animals during 6 h of dark and 6 h of light before and 3 days after VD or SH procedures. VD significantly increased distal vagina width (P Ͻ 0.001) and the length of the motor branch of the sacral plexus (P Ͻ 0.05), DNC (P Ͻ 0.05), and vesical nerves (P Ͻ 0.01) and decreased DNC frequency and amplitude of firing. VD occluded the pelvic urethra, inducing urinary retention, hematomas in the bladder, and thinness of the epithelial (P Ͻ 0.05) and detrusor (P Ͻ 0.01) layers of the bladder. Major pelvic ganglion parameters were not modified after VD. Rats dripped urine in unusual places to void, without the stereotyped behavior of micturition after VD. The neuroanatomic injuries after VD occur alongside behavioral signs of urinary incontinence as determined by a new behavioral tool for assessing micturition in conscious animals. external urethral sphincter; dorsal nerve of the clitoris; major pelvic ganglion; micturition MICTURITION consists of two phases: storage and urine expulsion. During storage, the detrusor is relaxed while the bladder neck and urethra are activated, preventing involuntary bladder emptying (11). Extrinsic elements such as the levator ani muscle also contribute to the maintenance of continence (3). When the bladder reaches its threshold volume, spinal and supraspinal reflexes are triggered to induce bladder contraction and urethral relaxation, and urine flows through the urethra (11). Damage to the lower urinary tract and/or its innervation can induce urinary dysfunction (3,29,41).Urinary dysfunction affects the health of many women (60). Stress urinary incontinence has been described as involuntary loss of urine during effort and is the most prevalent urinary disorder related to vaginal childbirth, which is known to injure the pudendal nerve and denervate the external urethral sphincter (EUS) (3, 15, 57).Maternal pelvic viscera and nerve damage results from the difficulty of human childbirth due the large fetal head and brain relative to the maternal pelvis size. Neonates at birth have heads that are close to the size of the maternal birth canal through which they must pass during the second stage of parturition (48). Births of fetuses over 4 kg or fetal malposition often prolong parturition (30), retaining the fetus in the pelvic cavity, the main anatomic resistance to fetal expulsion. Prolonged second stage of parturition...

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“…6,7 Underdiagnosis of DU is not clinically trivial. DU, rather than obstruction, has been found to be etiologic in a significant proportion (23-73%) of symptomatic elderly men, 8,9 an important observation since prostatic procedures intended to relieve obstruction in the presence of DU may be associated with poorer rates of improvement of LUTS and voiding function. 10,11 Three-quarters of symptomatic elderly women with urinary retention were found to have voiding dysfunction consistent with DU at urodynamic evaluation.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 Three-quarters of symptomatic elderly women with urinary retention were found to have voiding dysfunction consistent with DU at urodynamic evaluation. 8 Lack of recognition of DU may lead to mistaken symptombased diagnoses and inappropriate therapeutic measures. Once recognized, DU (and the potentially related condition of detrusor hyperactivity with impaired contractility, DHIC) is a frustrating diagnosis for clinician and often patient, as current therapeutic measures are largely palliative in nature and associated with significant morbidities.…”

Section: Introductionmentioning

confidence: 99%

Aging and the underactive detrusor: A failure of activity or activation?

Smith

2009

Neurourology and Urodynamics

124

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Impaired Detrusor Contractility in Community-Dwelling Elderly Presenting with Lower Urinary Tract Symptoms

Cited by 136 publications

References 24 publications

The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation

The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation

Neuroanatomic and behavioral correlates of urinary dysfunction induced by vaginal distension in rats

Aging and the underactive detrusor: A failure of activity or activation?

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