December 4, 2016

Re: Detrusor Underactivity and the Underactive Bladder: Symptoms, Function, Cause—What do we Mean? ICI-RS Think Tank 2014

Re: Detrusor Underactivity and the Underactive Bladder: Symptoms, Function, Cause—What do we Mean? ICI-RS Think Tank 2014

  • Alan J. Wein, MD, PhD (hon)

P. P. Smith, L. A. Birder, P. Abrams, A. J. Wein and C. R. Chapple
Department of Surgery, Center on Aging, University of Connecticut Health Center, Farmington, Connecticut, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh and Department of Urology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, and Bristol Urologic Institute, Southmead Hospital, Bristol and Department of Urology, Royal Hallamshire Hospital, Sheffield Hallam University, Sheffield, United Kingdom
Neurourol Urodyn 2016;35:312–317.doi: 10.1002/nau.22807

Editorial Comment

It seems like “underactive bladder” (UAB) and “detrusor underactivity” (DU) are 2 buzzwords that will constitute the focus of a subject that will be the point of discussion by those interested in lower urinary tract dysfunction for at least the next few years. The relationship of symptoms, function and cause constitutes the focus of this report resulting from a 2014 International Consultation on Incontinence-Research Society Think Tank titled, “Does detrusor underactivity exist, and if so is it neurogenic, myogenic, or both?” Although publication has obviously been delayed, the summary is still quite contemporary regarding the problems and pitfalls inherent in the definitions, diagnosis and therapy of the conditions encompassed by these 2 terms. Equating UAB with DU and impaired contractility is attempting simplification, which unfortunately leads only to confusion. The terms are not interchangeable.
Although proposals for improving terminology have emerged since this think tank, the authors provide a very good introduction to the conceptual overlap of symptoms (underactive bladder), function (detrusor underactivity) and etiology, and how the overlap of these circles may vary across subpopulations and within individuals as a consequence of disease and aging. Detrusor underactivity is a description of objective inadequacy of voiding, and, therefore, a measure of function and not etiology. A formal accepted definition of DU is lacking, and any such definition is relative to normal voiding characteristics and limited by an incomplete phenotyping of voiding in specific populations (ie based on age and gender).
The authors describe “impaired contractility” as indicating an inherent muscular failure to generate an adequate output in the presence of sufficient metabolic substrate and normal levels of neurological stimulation. They propose that “detrusor underactivity” should be preserved for urodynamic findings as described in the original International Continence Society definition, the problem being, of course, that no one knows what constitutes a contraction of reduced strength and/or duration, a normal time span or complete bladder emptying. The authors propose that “according to an integrative hypothesis, detrusor underactivity is a relative functional threshold deficiency resulting from failure of biological adaptation to multiple systemic failures.” They propose that “underactive bladder” should be reserved for the symptom complex of prolonged urination, with or without a sensation of incomplete bladder emptying, usually with hesitancy in a slow stream. This term should not be taken to imply a specific pathology or etiology and may or may not constitute an accurate perception of detrusor underactivity. However, that is to formally be finally defined. As the authors suggested at that think tank, focus groups are now trying to define what amounts to a symptom complex of underactive bladder and how this relates to clinically observed dysfunction (detrusor underactivity). However, that is to be defined in age specific and gender specific populations.
Although this summary is not the “last word” in contemporary discussions of the concepts of UAB, DU or impaired contractility, it is good background information for anyone interested in the subject with reference to the difficulties that arise when trying to define these entities. The “elephant in the room,” ie successful therapy or the lack of successful therapy, is left to subsequent discussions.

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Underactive bladder syndrome

Underactive bladder syndrome

Deborah Rigby 
Continence service manager. 
Bristol South and West PCT, Knowle West, Bristol
Nursing Standard. 19, 35, 57-68. http://dx.doi.org/10.7748/ns.19.35.57.s54

Double blind peer review

Underactive bladder syndrome causes difficulty in voiding, resulting in incomplete bladder emptying. This article describes common causes of the condition, patient assessment and the available management options.

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Management of bladder dysfunction in patients with multiple sclerosis

Management of bladder dysfunction in patients with multiple sclerosis

David Williams Urology specialist nurse. SureCalm Healthcare, Manchester

Nursing Standard. 26, 25, 39-46. http://dx.doi.org/10.7748/ns2012.02.26.25.39.c8951

Double blind peer review

Multiple sclerosis is a chronic disease of the central nervous system that often has a disabling effect, resulting in reduced quality of life for patients. Bladder dysfunction is a common and distressing symptom. Nurses can have a key role in the management of this symptom by promoting an integrated approach to care, thereby improving bladder control and reducing patient anxiety. This article explores the core elements of a specialist continence assessment in this patient group, and provides a critical overview of treatments used for managing bladder problems.



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September 12, 2016

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

The challenges in the diagnosis of detrusor underactivity in clinical practice: A mini-review.
Arab J Urol. 2016 Sep;14(3):223-7
Authors: Ahmed A, Farhan B, Vernez S, Ghoniem GM
Abstract
OBJECTIVE: To 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.
METHODS: We 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'.
RESULT: DU 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.
CONCLUSION: Currently, 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.
PMID: 27547465 [PubMed]
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August 23, 2016

Urothelial ATP signaling: what is its role in bladder sensation?


Urothelial ATP signaling: what is its role in bladder sensation?

Authors: Kentaro Takezawa, Makoto Kondo, Norio Nonomura, Shoichi Shimada

Abstract

AIM

Bladder functional disorders are common health problems; however, their pathologies are poorly understood. Adenosine triphosphate (ATP) released from the urothelium has been suggested to have an essential role in the micturition reflex, and its involvement in bladder functional disorders has been intensively investigated. Here, we review the latest advances in research on urothelial ATP signaling.

METHODS

We reviewed research articles on the role of the urothelium and urothelial ATP release in bladder function.

RESULTS

Mice lacking purinergic receptors have been reported to exhibit marked bladder hyporeflexia. Based on this observation, it was commonly believed, according to the widely held ATP urothelial signaling theory, that stretch-induced urothelial ATP release mediates the sensation of bladder filling via purinergic receptors. However, recent studies employing novel experimental methods and approaches have demonstrated that there are no significant differences in bladder function between wild-type and purinergic receptor knockout mice under physiological conditions. Nonetheless, under pathological conditions, inhibition of purinergic receptors has been shown to improve bladder hyperactivity. Moreover, enhanced urothelial ATP release has been reported in patients with bladder functional disorders.

CONCLUSIONS

Recently, conflicting evidence has led us to question the role of urothelial ATP signaling in normal micturition reflex. In contrast, under pathological conditions, it seems likely that enhanced urothelial ATP signaling mediates bladder hyperactivity. These recent findings suggest that the urothelial ATP signaling pathway is a potential therapeutic target for bladder functional disorders.
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August 12, 2016

A pilot study of cardiac electrophysiology catheters to map and pace bladder electrical activity.

A pilot study of cardiac electrophysiology catheters to map and pace bladder electrical activity.
Neurourol Urodyn. 2016 Aug 5;
Authors: Kelley RS, Vardy MD, Simons G, Chen H, Ascher-Walsh C, Brodman M
Abstract
AIMS: This is a pilot study to evaluate the feasibility of using diagnostic cardiac electrophysiology catheters for recording intrinsic urinary bladder electrical activity and for electrical pacing capture of bladder tissue.
METHODS: During cystoscopy, a curved quadripolar catheter was introduced and contact was made with the right and left halves of the dome and trigone in adult female patients undergoing cystoscopy. Electrical activity was recorded, using a commercially available cardiac electrophysiologic recording system, before and during pacing at 0.5-3.0 Hz.
RESULTS: Apparent spontaneous electrical depolarizations were detected in both the trigone and the dome. The amplitude of these depolarizations was in the microVolt range. During pacing, local electrical capture was noted in the trigone, but not in the dome.
CONCLUSIONS: Spontaneous low-amplitude electrical activity was detected in the bladder through the use of commercially available cardiac electrophysiology equipment. While these low-level signals could represent noise, the voltage, and morphology resemble detrusor muscle action potentials previously seen in animal studies. Pacing induced local electrical capture in the trigone but not the dome.
PMID: 27494644 [PubMed - as supplied by publisher]
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August 6, 2016

Review of “The Nurse Practitioner in Urology”

Review of “The Nurse Practitioner in Urology”


Hollander, J.B. Int Urol Nephrol (2016). doi:10.1007/s11255-016-1374-0
Urology - Book review

There is a great need in the world for skilled urologic practitioners. Urology physician extenders such as nurse practitioners, physician assistants and specialty trained medical assistants will be needed more and more in order to deliver timely and appropriate care to urologic patients. The office practice manual “The Nurse Practitioner in Urology” is now available and has the potential to become a main resource for office practice in urology. Written by urology nurse practitioners with over 32 years of urologic experience between them, the book serves as a guide for physician extenders in order to provide expert high quality cost effective care for adult urology patients. The book to me is so well written and practical that it may serve as a resource for office urologists themselves. The chapter highlights pertinent pathophysiology, assessment and diagnostics specific to GU conditions and promotes advanced critical thinking for physician extenders specializing in urology. The chapters are written with clinical pearls and practical resources that may be of value not only to physician extenders, but clinicians and patients themselves. In addition to standard outpatient management of both benign and malignant urological conditions, there are chapters on transitioning pediatric urology patients to adult environments, men’s health including low testosterone, erectile dysfunction and infertility, and newer concepts with regard to urinary retention and underactive bladder. The book emphasizes evidence based medicine and the resources necessary to practice in that fashion. The book is user friendly and easy to navigate. “The Nurse Practitioner in Urology” will be a valued asset to all mid-level providers, physician extenders and specialists in the office based practice in urology. I suspect it will be a valued asset to busy state-of-the-art urological offices.

© Springer Science+Business Media Dordrecht 2016

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July 31, 2016

A cross-sectional study in the USA of the epidemiology and quality of life of underactive bladder symptoms.

A cross-sectional study in the USA of the epidemiology and quality of life of underactive bladder symptoms.
Int Urol Nephrol. 2016 Jul 29;
Authors: Faraj K, Doo F, Boura J, Vereecke A, Chancellor MB
Abstract
PURPOSE: To assess the prevalence, awareness, and quality of life (QOL) impact of symptoms suggestive of underactive bladder (UAB) in the USA.
METHODS: A thirteen-item paper survey was mailed to 25,000 individuals 60 years or older living in the USA. It aimed to collect information relating to demographics, familiarity with UAB, patient urinary symptoms, and QOL concerns.
RESULTS: Nine hundred and seventy-seven survey participants were stratified into four groups based on the number of UAB symptoms (straining, retention, and difficulty emptying) present: zero, one, two, and three. As the number of reported UAB symptoms increased, there was an increase prevalence in nocturia, urge, and urinary frequency (p < 0.0001). Increased UAB symptoms were associated with an increased prevalence of concerns related to urgency, urge incontinence, nocturia, and overall urinary status (p < 0.0001). Urology visits were most common in individuals who reported the most UAB symptoms (p < 0.0001); however, there was no difference among groups with regard to UAB awareness. Women were less likely to report any UAB symptoms (p < 0.0001), symptoms of urge (p = 0.001), retention (p = 0.002), difficulty emptying their bladder (p < 0.0001), a history of catheter use for retention (P = 0.002), and urology visits in the past 3 years (p < 0.0001). This study is limited in its inability to differentiate UAB from disorders that may mimic UAB clinically, based on the survey questions asked.
CONCLUSIONS: Underactive bladder symptoms are common and can have a significant impact on ones QOL, although awareness is still lacking among potentially affected individuals. More must be done to allow one to better differentiate between UAB and conditions that are clinically similar.
PMID: 27473156 [PubMed - as supplied by publisher]
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July 30, 2016

Phenotyping women with detrusor underactivity by presumed etiology: Is it plausible?

Phenotyping women with detrusor underactivity by presumed etiology: Is it plausible?
Neurourol Urodyn. 2016 Jul 26;
Authors: Brown ET, Cohn JA, Kaufman MR, Dmochowski RR, Reynolds WS
Abstract
AIMS: Underactive bladder (UAB) is a symptom complex with poorly characterized causation. The aim of this study was to determine if clinical and UDS parameters differed between categories of presumed detrusor underactivity (DU) etiologies.
METHODS: A retrospective review was performed at a single institution from 2011 to 2015 to identify patients with symptoms of UAB. Patients were excluded if they were male, had anti-incontinence, or pelvic organ prolapse (POP) surgery within 1 year, or the UDS did not demonstrate DU as defined within. Subjects were stratified by etiology into four cohorts: cardiovascular disease manifestations (CV), cardiac risk factors (CVR), neurologic (N), or idiopathic (I). Patient demographics, comorbidities, symptomatology, physical exam, and UDS parameters were compared.
RESULTS: A total of 200 patients met inclusion criteria (CV: n = 53 [26.5%], CVR: n = 44 [22%] N: n = 81 [40.5%], I: n = 22 [11%]). Women in the CV cohort were significantly older and more likely to be post-menopausal (P < 0.001). There were no differences between cohorts for BMI (P = 0.48), recurrent UTI (P = 0.63), history of urinary retention (AUR) (P = 0.65), POP (0.49), American Urological Association Symptom Score (AUA-SS) (P = 0.06), presenting symptomatology [urgency, frequency, urgency urinary incontinence, AUR, incomplete emptying, hesitancy, UTI (P = 0.97)], or UDS parameters (first sensation [P = 0.25], normal desire [P = 0.80], strong desire [P = 0.58], capacity [P = 0.11], Qmax [P = 0.50], Pdet at Qmax [P = 0.22], post-void residual [P = 0.82]).
CONCLUSIONS: Though differences were observed between cohorts for age and menopausal status, clinical or urodynamic parameters did not demonstrate distinct differences across presumed categories of etiology, suggesting that the etiology of DU may be multifactorial. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc.
PMID: 27460338 [PubMed - as supplied by publisher]
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July 23, 2016

Functional and Molecular Characterization of Hyposensitive Underactive Bladder Tissue and Urine in Streptozotocin-Induced Diabetic Rat.

Functional and Molecular Characterization of Hyposensitive Underactive Bladder Tissue and Urine in Streptozotocin-Induced Diabetic Rat.
PLoS One. 2014;9(7):e102644
Authors: Nirmal J, Tyagi P, Chuang YC, Lee WC, Yoshimura N, Huang CC, Rajaganapathy B, Chancellor MB
Abstract
BACKGROUND: The functional and molecular alterations of nerve growth factor (NGF) and Prostaglandin E2 (PGE2) and its receptors were studied in bladder and urine in streptozotocin (STZ)-induced diabetic rats.
METHODOLOGY/PRINCIPAL FINDINGS: Diabetes mellitus was induced with a single dose of 45 mg/kg STZ Intraperitoneally (i.p) in female Sprague-Dawley rats. Continuous cystometrogram were performed on control rats and STZ treated rats at week 4 or 12 under urethane anesthesia. Bladder was then harvested for histology, expression of EP receptors and NGF by western blotting, PGE2 levels by ELISA, and detection of apoptosis by TUNEL staining. In addition, 4-hr urine was collected from all groups for urine levels of PGE2, and NGF assay. DM induced progressive increase of bladder weight, urine production, intercontraction interval (ICI) and residual urine in a time dependent fashion. Upregulation of Prostaglandin E receptor (EP)1 and EP3 receptors and downregulation of NGF expression, increase in urine NGF and decrease levels of urine PGE2 at week 12 was observed. The decrease in ICI by intravesical instillation of PGE2 was by 51% in control rats and 31.4% in DM group at week 12.
CONCLUSIONS/SIGNIFICANCE: DM induced hyposensitive underactive bladder which is characterized by increased inflammatory reaction, apoptosis, urine NGF levels, upregulation of EP1 and EP3 receptors and decreased bladder NGF and urine PGE2. The data suggest that EP3 receptor are potential targets in the treatment of diabetes induced underactive bladder.
PMID: 25050870 [PubMed - as supplied by publisher]
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July 4, 2016

Differences in urodynamic variables for vesicoureteral reflux depending on the neurogenic bladder type.

Differences in urodynamic variables for vesicoureteral reflux depending on the neurogenic bladder type.
Ann Rehabil Med. 2014 Jun;38(3):347-52
Authors: Lee JS, Koo BI, Shin MJ, Chang JH, Kim SY, Ko HY
Abstract
OBJECTIVE: To compare the urodynamic study variables at the onset of vesicoureteral reflux (VUR) between the overactive and underactive bladders in patients with spinal cord injury who presented with VUR.
METHODS: A total of 28 (13 cases of detrusor overactivity and 15 detrusor underactivity) men were enrolled. We compared the urodynamic variables between the two groups; detrusor pressure and bladder compliance, the infused volume at the onset of VUR measured on a voiding cystourethrography and cystometric capacity, maximum detrusor pressure, and bladder compliance during filling cystometry were recorded.
RESULTS: At the onset of VUR, the bladder volume and compliance, except for the detrusor pressure, showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance relative to the cystometric capacity showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance at the onset of VUR relative to the cystometric bladder capacity did not show any significant difference between the two groups.
CONCLUSION: There were differences in some variables at the onset of VUR depending on the type of neurogenic bladder. The VUR occurred at a lower capacity in neurogenic bladder with detrusor overactivity than in neurogenic bladder with detrusor underactivity at the same pressure. VUR occurred at a lower intravesical pressure compared to that known as the critical detrusor pressure (≥40 cm H2O) required for the development of VUR. The results of our study demonstrate that the detrusor pressure should be maintained lower than the well known effective critical detrusor pressure for the prevention and treatment of VUR.
PMID: 25024958 [PubMed]
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June 22, 2016

Re: The Overactive Bladder Progression to Underactive Bladder Hypothesis.

Re: The Overactive Bladder Progression to Underactive Bladder Hypothesis.
J Urol. 2016 Apr;195(4P1):1040
Authors: Wein AJ
PMID: 27302797 [PubMed - in process]
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May 30, 2016

A ventral root avulsion injury model for neurogenic underactive bladder studies.

A ventral root avulsion injury model for neurogenic underactive bladder studies.
Exp Neurol. 2016 May 21;
Authors: Chang HH, Havton LA
Abstract
Detrusor underactivity (DU) is defined as a contraction of reduced strength and/or duration during bladder emptying and results in incomplete and prolonged bladder emptying. The clinical diagnosis of DU is challenging when present alone or in association with other bladder conditions such as detrusor overactivity, urinary retention, detrusor hyperactivity with impaired contractility, aging, and neurological injuries. Several etiologies may be responsible for DU or the development of an underactive bladder (UAB), but the pathobiology of DU or UAB is not well understood. Therefore, new clinically relevant and interpretable models for studies of UAB are much needed in order to make progress towards new treatments and preventative strategies. Here, we review a neuropathic cause of DU in the form of traumatic injuries to the cauda equina (CE) and conus medullaris (CM) portions of the spinal cord. Lumbosacral ventral root avulsion (VRA) injury models in rats mimic the clinical phenotype of CM/CE injuries. Bilateral VRA injuries result in bladder areflexia, whereas a unilateral lesion results in partial impairment of lower urinary tract and visceromotor reflexes. Surgical re-implantation of avulsed ventral roots into the spinal cord and pharmacological strategies can augment micturition reflexes. The translational research need for the development of a large animal model for UAB studies is also presented, and early studies of lumbosacral VRA injuries in rhesus macaques are discussed.
PMID: 27222131 [PubMed - as supplied by publisher]
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May 19, 2016

Re: The Underactive Bladder: A New Clinical Concept?

Re: The Underactive Bladder: A New Clinical Concept?
J Urol. 2016 Jun;195(6):1831
Authors: Wein AJ
PMID: 27191085 [PubMed - as supplied by publisher]
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May 16, 2016

Meningitis-retention Syndrome; A Case Report.

Meningitis-retention Syndrome; A Case Report.
Urol Case Rep. 2016 May;6:42-4
Authors: Ishii G, Hata K, Aoki S, Suzuki M, Kimura T, Egawa S
Abstract
We report a case of meningitis-retention syndrome followed by urodynamic tests. A 48-year-old man was admitted to the hospital for an undiagnosed fever with headache and urinary retention. Aseptic meningitis was suspected according to cerebrospinal fluid analyses, and urodynamic test showed an underactive detrusor, leading to inadequate contraction of the bladder on voiding in spite of a normal sensation during bladder filling. Clean intermittent self-catheterization was required temporarily, but normal urinary voiding without the need for medication was restored in 2 weeks after discharge from the hospital, when urodynamic tests showed normal contractility of the bladder during voiding. 
PMID: 27175342 [PubMed]
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April 29, 2016

Phasic changes in bladder compliance during filling cystometry of the neurogenic bladder.

Phasic changes in bladder compliance during filling cystometry of the neurogenic bladder.
Ann Rehabil Med. 2014 Jun;38(3):342-6
Authors: Kim SY, Ko SH, Shin MJ, Park YJ, Park JS, Lee KE, Ko HY
Abstract
OBJECTIVE: To investigate phasic changes during filling cystometry that most accurately represent detrusor properties, regardless of other factors affecting detrusor contractility.
METHODS: Seventy-eight patients (59 males, 19 females; mean age, 48.2 years) with spinal cord injuries were enrolled. Urodynamic studies were performed using a normal saline filling rate of 24 mL/min. We calculated bladder compliance values of the detrusor muscle in each of three filling phase intervals, which divided the filling cystometrogram into three phases referable to the cystometric capacity or maximum cystometric capacity. The three phases were sequentially delineated by reference to the pressure-volume curve reflecting bladder filling.
RESULTS: Bladder compliance during the first and second phases of filling cystometry was significantly correlated with overall bladder compliance in overactive detrusors. The highest coefficient of determination (r(2)=0.329) was obtained during the first phase of the pressure-volume curve. Bladder compliance during all three phases was significantly correlated with overall bladder compliance of filling cystometry in underactive detrusors. However, the coefficient of determination was greatest (r(2)=0.529) during the first phase of filling cystometry.
CONCLUSION: Phasic bladder compliance during the early filling phase (first filling phase) was the most representative assessment of overall bladder compliance during filling cystometry. Careful determination of early phase filling is important when seeking to acquire reliable urodynamic data on neurogenic bladders.
PMID: 25024957 [PubMed]
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April 27, 2016

Pharmacotherapy in detrusor underactivity: A new challenge for urologists and pharmacologists (from lab to clinic).

Pharmacotherapy in detrusor underactivity: A new challenge for urologists and pharmacologists (from lab to clinic).
Pharmacol Rep. 2016 Mar 19;68(4):703-706
Authors: Juszczak K, Drewa T
Abstract
Higher incidence of functional urinary bladder dysfunction (detrusor overactivity - DO and detrusor underactivity - DU) occurs in elderly people. Effective therapy is widely used in patients with DO, in contrast DU seems to be a serious burden for the older population due to the lack of successful treatment. The aim of the study was to review the potential pharmacological targets in DU treatment in the animal model. This review is based on systemic literature research. The Medline/Pubmed, Scopus, Embase, and Web of Science databases were searched in order to identify original and review articles, as well as editorials relating to underactive bladder, detrusor underactivity. The following Medical Subject Headings (MeSH) terms were used to ensure the sensitivity of the searches: urinary bladder, animal models, humans and therapy. 19 papers met the criteria and were included for this review. 19 papers met the criteria and were included for this review. The pathophysiology of DU and its animal models were described. Moreover, the potential pharmacological targets in DU therapy were discussed, such as bombesin receptors, prostaglandin-, ATP-, NO-, CGRP-, SP-, Dopamine-, NGF-, M2-, and agrin-dependent pathways. In conclusion, due to the lack of effective treatment strategies in DU, further research is necessary. Close cooperation between urologists and pharmacologists should be maintained for optimal research on DU pharmacotherapy.
PMID: 27110877 [PubMed - as supplied by publisher]
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April 25, 2016

The underactive bladder: detection and diagnosis.

The underactive bladder: detection and diagnosis.
F1000Res. 2016;5
Authors: Osman N, Mangera A, Hillary C, Inman R, Chapple C
Abstract
The inability to generate a voiding contraction sufficient to allow efficient bladder emptying within a reasonable time frame is a common problem seen in urological practice. Typically, the symptoms that arise are voiding symptoms, such as weak and slow urinary flow. These symptoms can cause considerable bother to patients and impact upon quality of life. The urodynamic finding of inadequate detrusor contraction has been termed detrusor underactivity (DUA). Although a definition is available for this entity, there are no widely accepted diagnostic criteria. Drawing parallels to detrusor overactivity and the overactive bladder, the symptoms arising from DUA have been referred to as the "underactive bladder" (UAB), while attempts to crystallize the definition of UAB are now ongoing. In this article, we review the contemporary literature pertaining to the epidemiology and etiopathogenesis of DUA as well as discuss the definitional aspects that are currently under consideration. 
PMID: 27081483 [PubMed]
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April 22, 2016

The vexing problem of underactive bladder in children: a viable alternative.

Related Articles
The vexing problem of underactive bladder in children: a viable alternative.
BJU Int. 2016 May;117(5):712-3
Authors: Bauer SB
PMID: 27079477 [PubMed - in process]

April 11, 2016

Lower Urinary Tract and Sexual Dysfunction in Neurological Patients.

Lower Urinary Tract and Sexual Dysfunction in Neurological Patients.
Eur Neurol. 2014 Jul 2;72(1-2):109-115
Authors: VoduĊĦek DB
Abstract
Background: Lower urinary tract dysfunction (LUTD) and sexual dysfunction (SD) are common in neurological patients due to a combination of lesions affecting relevant neural control, constraints imposed by sensorimotor and cognitive deficits and - particularly for SD - psychosocial consequences of chronic neurological disease. Summary: This review summarizes the etiology, diagnosis and treatment of LUTD and SD in neurological patients. Key Messages: LUTD may lead to serious health problems; both LUTD and SD significantly affect quality of life. Management of patients with spinal cord injury and dysraphism is undertaken in specialized centers according to established guidelines. Treatment of neurological patients with noncomplicated neurogenic LUTD or SD should preferentially be guided by a neurologist. Clinical Impact: For rational treatment of urinary symptoms, an accurate assessment is mandatory; the bladder and the sphincter need to be defined as normal, over- or underactive. Urodynamic testing is the gold standard for functional diagnosis; assessment of residual urine and uroflow are the minimal requirements before considering management. Dysfunction of desire, arousal and orgasm (ejaculation) may be diagnosed by medical history and are amenable to counselling and treatment, which is - in the case of erectile dysfunction - evidence based. Further high-quality studies are necessary to test the best approaches for diagnosing and managing particular types of neurogenic LUTD and SD in the different neurological patient populations. © 2014 S. Karger AG, Basel.
PMID: 24993182 [PubMed - as supplied by publisher]
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April 2, 2016

Detrusor underactivity: Pathophysiological considerations, models and proposals for future research. ICI-RS 2013.

Detrusor underactivity: Pathophysiological considerations, models and proposals for future research. ICI-RS 2013.
Neurourol Urodyn. 2014 May 16;
Authors: van Koeveringe GA, Rademakers KL, Birder LA, Korstanje C, Daneshgari F, Ruggieri MR, Igawa Y, Fry C, Wagg A
Abstract
AIMS: Detrusor underactivity, resulting in either prolonged or inefficient voiding, is a common clinical problem for which treatment options are currently limited. The aim of this report is to summarize current understanding of the clinical observation and its underlying pathophysiological entities.
METHODS: This report results from presentations and subsequent discussion at the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, 2013.
RESULTS AND CONCLUSIONS: The recommendations made by the ICI-RS panel include: Development of study tools based on a system's pathophysiological approach, correlation of in vitro and in vivo data in experimental animals and humans, and development of more comprehensive translational animal models. In addition, there is a need for longitudinal patient data to define risk groups and for the development of screening tools. In the near-future these recommendations should lead to a better understanding of detrusor underactivity and its pathophysiological background. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.
PMID: 24839258 [PubMed - as supplied by publisher]
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March 31, 2016

Efficacy and Safety of Intravesical Onabotulinumtoxin A Injection in Patients with Detrusor Hyperactivity and Impaired Contractility.

Efficacy and Safety of Intravesical OnabotulinumtoxinA Injection in Patients with Detrusor Hyperactivity and Impaired Contractility.
Toxins (Basel). 2016;8(3)
Authors: Wang CC, Lee CL, Kuo HC
Abstract
We investigated the efficacy and safety of intravesical onabotulinumtoxinA injection in patients with detrusor hyperactivity and impaired contractility (DHIC). Twenty-one patients with urodynamically proven DHIC and 21 age-matched patients with overactive bladder (OAB) with urodynamic detrusor overactivity were treated with intravesical injections of 100 U of onabotulinumtoxinA. The overactive bladder symptom score, urgency severity score, patient perception of bladder condition, global response assessment, voiding diary, and procedure-related adverse events (AE) at baseline, two weeks, one, three, and six months after treatment were assessed. The results showed that the subjective symptom scores improved significantly in both groups, and the scores did not differ between the groups. The decrease in urgency episodes and urgency urinary incontinence were noted in OAB patients but not in DHIC patients. Although the incidence of AEs was comparable between the groups, the therapeutic efficacy lasted for a mean of 4.9 ± 4.8 months in DHIC patients and 7.2 ± 3.3 months in OAB patients (p = 0.03). We concluded that the efficacy of intravesical onabotulinumtoxinA injection for DHIC patients was limited and short-term. Nevertheless, AEs did not increase in DHIC. Intravesical onabotulinumtoxinA might not be a good indication in patients with DHIC and high post-voiding residual urine. Physicians should inform patients of the potential benefits and risks of onabotulinumtoxinA injection for treatment of DHIC.
PMID: 26999209 [PubMed - as supplied by publisher]
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March 19, 2016

The many faces of impaired bladder emptying.

The many faces of impaired bladder emptying.
Curr Opin Urol. 2014 Apr 21;
Authors: Andersson KE
Abstract
PURPOSE OF REVIEW: Impaired bladder emptying is a common clinical problem for which currently no effective drug treatment is available. There has been an increasing interest in the condition, and the present review updates the terminology issues, common causes, and potential future pharmacological treatment possibilities.
RECENT FINDINGS: Impaired bladder emptying can be described in many ways, but general agreement on the terminology has not yet been reached. The disorder can have many underlying causes, including aging, bladder outflow obstruction, diabetes mellitus, and neurogenic disturbances. There is no effective pharmacological treatment, and to what extent drug treatment of the associated morbidities (e.g., diabetes mellitus, Parkinson's disease, and multiple sclerosis) also can improve impaired bladder emptying has only been investigated to a limited extent.
SUMMARY: Impaired bladder emptying may be caused by a spectrum of pathophysiologically defined disorders. To describe the condition, underactive bladder (UAB) can be used as a general term, covering detrusor underactivity as the urodynamic diagnosis, and the UAB syndrome for its symptomatic manifestations. In order to understand UAB, identification of the underlying cause(s) is necessary. Effective pharmacologic therapy is lacking and further basic research is needed to find targets for treatment.
PMID: 24752226 [PubMed - as supplied by publisher]
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March 16, 2016

Urological evaluation of patients that had undergone in utero myelomeningocele closure: A prospective assessment at first presentation and early follow-up. Do their bladder benefit from it?

Urological evaluation of patients that had undergone in utero myelomeningocele closure: A prospective assessment at first presentation and early follow-up. Do their bladder benefit from it?
Neurourol Urodyn. 2014 Apr 11;
Authors: Macedo A, Leal M, Rondon A, Ortiz V, Moron AF, Cavalheiro S
Abstract
AIMS: To report our data on initial urological presentation after in utero myelomeningocele (MMC) closure.
METHODS: A prospective urological assessment at first presentation was designed for patients that had undergone in utero MMC closure and referred to our urological facility. The protocol consisted of detailed medical history, renal sonography, voiding cystourethrogram, and urodynamic evaluation.
RESULTS: In utero MMC closure was performed in 19 patients at gestational age of 25.6 weeks 25-27. Birth occurred at a mean gestational age of 31.8 weeks 26-36. Hyperactive bladder was observed in 89.5% 17/19. Bladder compliance was normal in two cases (10.5%), was markedly reduced in 10 patients (52.6%) and not possible to be determined due to urinary leakage in 7 patients (36.8%). We observed normal bladder capacity in 8 patients (42.1%), reduced in 11 (57.9%), and detrusor-sphincter dyssynergia in 9 patients (47.4%). Underactive bladder was diagnosed in one case. Clean Intermittent Catheterization was initiated by 11 patients (57.9%) mostly in association with anticholinergics 10/11. Vesicoureteral reflux was found in 5 patients (26.3%) and 9 had pyelonephritis at a mean follow-up of 5.4 months 2-17.
CONCLUSIONS: Our data suggested that despite in utero MMC surgery, patients are at risk for bladder abnormal function and renal deterioration and should be aggressively treated, not differently from those operated in the post-natal term. This study has the merit of being a prospectively set evaluation performed by one investigator, including the urodynamic study. We acknowledge the need of long-term follow up. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.
PMID: 24729268 [PubMed - as supplied by publisher]
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March 11, 2016

Updates of underactive bladder: a review of the recent literature.

Updates of underactive bladder: a review of the recent literature.
Int Urol Nephrol. 2016 Mar 1;
Authors: Li X, Liao L
Abstract
Underactive bladder (UAB) is a major component of lower urinary tract symptoms. The physiopathology mechanisms underlying UAB include detrusor underactivity, acontractile detrusor, and reduced or absent bladder sensation. UAB can influence lower and upper urinary tract function and lead to serious consequences; however, the symptom syndrome is poorly understood and incompletely researched at present. Moreover, there is no agreement among authorities regarding the terminology, definition, epidemiology, classification, risk factors, animal model, pathogenesis, diagnosis, and treatment of UAB. In this review, we discuss the current terminology, epidemiology, physiopathology, evaluation, and management of UAB.
PMID: 26931421 [PubMed - as supplied by publisher]
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March 4, 2016

Underactive bladder in women: is there any evidence?

Underactive bladder in women: is there any evidence?
Curr Opin Urol. 2016 Feb 26;
Authors: Cohn JA, Brown ET, Kaufman MR, Dmochowski RR, Reynolds WS
Abstract
PURPOSE OF REVIEW: Underactive bladder (UAB) is a clinical symptom complex only recently gaining recognition as a clinical diagnosis. Lack of consensus agreement on a definition of UAB has limited its recognition and diagnosis in clinical practice. The purposes of this review are to: present existing definitions of UAB, review recent data regarding clinical and urodynamic diagnosis of the condition, and examine up-to-date hypotheses regarding its pathophysiology, with a focus on women.
RECENT FINDINGS: The process to develop a consensus definition for UAB as a clinical symptom complex is ongoing. Symptoms associated with UAB, such as weak stream, straining to void, and history of urinary retention are well correlated to detrusor underactivity on urodynamics, which frequently develops in elderly women. In addition to aging, UAB may be the end stage of a variety of contributing pathologic conditions such as diabetes and ischemic disease. In some women, UAB may result from a progression from overactive bladder to UAB.
SUMMARY: Existing evidence supports UAB in women as a symptom complex with a clinical and pathophysiologic profile distinguishable from other lower urinary tract-associated clinical conditions. Consensus definitions of clinical and urodynamic diagnostic parameters will be essential to more widespread recognition of UAB.
PMID: 26927630 [PubMed - as supplied by publisher]
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