Will detrusor acontractility recover after medical or surgical treatment? A longitudinal long‐term urodynamic follow‐up

Abstract

Aims: Patients with urinary retention due to detrusor acontractility (DA) might regain voiding efficiency (VE) after treatment. This study investigated the long-term outcomes and predictors of recovery following treatment. Methods: A total of 32 patients with DA were retrospectively identified and enrolled. DA was defined by P det .Q max = 0 cmH 2 O and postvoid residual (PVR) > 300 ml determined through videourodynamic study (VUDS). All patients received medical or surgical treatment and were followed up for at least 3 months, during which repeat VUDS was conducted. Detrusor contractility recovery was confirmed when patients were able to void with a P det .Q max ≥ 10 cmH 2 O after treatment. Results: Our patients comprised 22 women and 10 men (mean age, 73.2 ± 9.7 years; mean follow-up duration, 1.6 ± 1.8 [0.3-7.4] years). Follow-up VUDS revealed that 14 (43.9%) patients recovered from detrusor contractility, with five patients recovering within 1 year and nine after 1 year. P det .Q max , voided volume, PVR, maximum flow rate, and VE significantly improved in both the recovery and nonrecovery groups. The recovery group had significantly better VE (p = .039) and significantly lower bladder compliance (74.2 ± 83.2 vs. 119 ± 82.6; p = .007) than the nonrecovery group. Receiver operating characteristic (ROC) analysis revealed an optimum bladder compliance cutoff value of <80 ml/cmH 2 O for predicting detrusor contractility recovery with an area under the ROC curve of 0.780. Conclusions: Among the included patients with DA, 43.9% had detrusor contractility recovery after treatment, with bladder compliance of <80 ml/ cmH 2 O predicting bladder function recovery.

Therapeutic outcome of active management in male patients with detrusor underactivity based on clinical diagnosis and videourodynamic classification

“…Interestingly, we also noticed that patients with detrusor acontractile and chronic urinary retention could regain their detrusor contractility and voiding ability after medical or surgical treatment. A total of 43.9% of patients with DA could have detrusor function recovery after treatment, a bladder compliance of less than 80 ml/cmH 2 O could predict the recovery 27 . These patients might have residual detrusor contractility and had urodynamically higher Pdet and lower bladder compliance, suggesting these patients did not completely lose their detrusor function and had a better chance to regain effective detrusor contractility and adequate voiding efficiency 21 .…”

High percentage of neurologic deficits in the electrophysiology study of the lower urinary tract in patients with detrusor underactivity and chronic urinary retention

“…Urethral sphincter botulinum toxin A injection had been demonstrated to be effective in restoring spontaneous urination or detrusor contractility in patients with urodynamic DU and chronic urinary retention 19 . Bladder outlet surgeries, including urethral sphincter botulinum toxin A injection, transurethral incision of bladder neck, and transurethral incision or resection of the prostate, can also effectively improve voiding efficiency and decrease the post‐void residual in most patients with DU 13,20 . However, patients with DU who have urethral sphincter denervation, absent BCR, or pudendal nerve neuropathy might not benefit from these active treatments.…”

“…19 Bladder outlet surgeries, including urethral sphincter botulinum toxin A injection, transurethral incision of bladder neck, and transurethral incision or resection of the prostate, can also effectively improve voiding efficiency and decrease the post-void residual in most patients with DU. 13,20 However, patients with DU who have urethral sphincter denervation, absent BCR, or pudendal nerve neuropathy might not benefit from these active treatments. Therefore, only 60% of patients with neurogenic or non-neurogenic DU can have successful treatment outcome after urethral sphincter botulinum toxin A injection.…”

Detrusor Underactivity in Men with Bladder Outlet Obstruction

“…On the other hand, age, prostate size, baseline PVR, first sensation, full sensation and urgency sensation were unrelated to the voiding function recovery. The optimal cutoff value of these parameters has not yet been established but Chen et al have proposed that bladder compliance of <80 mL/cmH2O may predict better bladder function recovery [ 72 ].…”