The challenges in the diagnosis of detrusor underactivity in clinical practice: A mini-review

Abstract

ObjectiveTo review the current definitions, terminology, epidemiology and aetiology of detrusor underactivity (DU), with specific attention to the diagnostic criteria in use. In addition, we address the relation and the overlap between DU and bladder outlet obstruction (BOO). In this mini-review, we hope to help identify DU patients and facilitate structured clinical evaluation and research.MethodsWe searched the English literature using ScienceDirect and PubMed for relevant articles. We used the following terms: ‘detrusor underactivity’, ‘underactive bladder’, ‘post voiding residual’, ‘post micturition residual’, ‘acontractile bladder’, ‘detrusor failure’, and ‘detrusor areflexia’.ResultDU is one of the most common conditions causing lower urinary tract symptoms (LUTS). Unfortunately, it is also the most poorly understood bladder dysfunction with scant research. To our knowledge there is no clear definition and no non-invasive method to characterise this important clinical condition. DU may result from the normal ageing process; however, it has multiple aetiologies including neurogenic and myogenic dysfunction. In many cases the symptoms of DU are similar to those of BOO and it usually requires invasive urodynamic study (UDS) for diagnosis to differentiate the two diagnoses. A number of diagnostic tests may be used including: UDS testing, the Schafer pressure/flow nomogram, linear passive urethral resistance relation, Watts factor, and the bladder contractility index. Of these, UDS testing is the most practical as it determines both the maximum urinary flow rate and the pressure exerted by the detrusor muscle relative to the maximal flow of urine, allowing for precise characterisation of detrusor function.ConclusionCurrently, the diagnosis of DU is based on invasive urodynamic parameters as defined by the International Continence Society in 2002. There is no consensus for the definition of DU prior to 2002. As there is significant overlap between the symptoms of DU and BOO, it is difficult to diagnose DU clinically.

Urodynamic factors associated with the large capacity bladder and incomplete emptying after prolapse repair (2009‐2015)

“…While these indices are quantifiable in women using Qmax and Pdet@Qmax, they were originally described in male patients with varying grades of bladder outlet obstruction. Our findings are consistent with what has been previously reported in the literature, [23][24][25] and thus corroborate the poor applicability of these indices to female lower urinary tract physiology.…”

<p>The Prevalence of Detrusor Underactivity and its Symptoms Co-relation with Urodynamic Study Findings in Patients with Lower Urinary Tract Symptoms</p>

“…A Pdet@Qmax of >40 cmH2O is accepted as normal; 30-40 cmH2O as mild; 20-30 cmH2O as moderate, and <20 cmH2O as severe DU. 9 All patients have signed a formal written consent to perform UDS and to use their anonymous information in clinical research as part of the IUC policy.…”

“…7 Another study from Australia has stated that the prevalence of DU in this study was 23%. 8 DU was previously considered as secondary to the aging process, 9 but it affects different patient groups, suggesting a multifactorial etiology including both myogenic and neurogenic etiologies. [9][10][11] Recently, DU as a cause of LUTS in both men and women has been increasingly gaining attention.…”

“…8 DU was previously considered as secondary to the aging process, 9 but it affects different patient groups, suggesting a multifactorial etiology including both myogenic and neurogenic etiologies. [9][10][11] Recently, DU as a cause of LUTS in both men and women has been increasingly gaining attention. There is a major issue in the differentiation of underactive bladder symptoms and other causes of lower urinary tract symptoms such as detrusor hyperactivity and impaired contractility (DHIC), hypersensitive bladder (HSB), detrusor overactivity (DO), bladder outlet obstruction (BOO) 12 and Dysfunctional Voiding (DV).…”

The Role of Parathyroid Hormone-Related Protein in Pathogenesis of Disorders of Bladder Contractile Function

“…Термины, включая малоактивный мочевой пузырь, недостаточность активности детрузора и нарушенная сократимость мышечных структур мочевого пузыря, описывают аспекты этих проблем и используются несколько взаимозаменяемо. Возможно, что отсутствие клинического эффекта при лечении данной патологии во многих случаях связано с этиологической и диагностической неточностью, обусловленной отсутствием четких терминологических определений [25,26].…”