July 30, 2017

Re: Factors Impacting Bladder Underactivity and Clinical Implications

Re: Factors Impacting Bladder Underactivity and Clinical Implications

Alan J. Wein, MD, PhD (hon)

DOI: http://dx.doi.org/10.1016/j.juro.2016.08.073

July 17, 2017

Re: Unravelling Detrusor Underactivity: Development of a Bladder Outlet Resistance-Bladder Contractility Nomogram for Adult Male Patients with Lower Urinary Tract Symptoms

  • Tomas L. Griebling, MD, MPH

M. Oelke, K. L. Rademakers and G. A. van Koeveringe; FORCE Research Group, Maastricht and Hannover
Department of Urology, Hannover Medical School, Hannover, Germany, and Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
Neurourol Urodyn 2015; Epub ahead of print.doi: 10.1002/nau.22841

Editorial Comment

Underactive bladder is gaining increased attention as a clinical entity that tends to occur predominantly in older adults. Symptomatically this condition most often manifests as urinary retention with incomplete bladder emptying. The condition can also be associated with other lower urinary tract symptoms such as urinary urgency, frequency, nocturia and poor urinary stream. In men this condition can be challenging to differentiate from symptoms caused by bladder outlet obstruction. Detrusor underactivity, a component of the underactive bladder syndrome, has not been clearly defined from a physiological perspective.
This study was conducted to create a nomogram for voiding parameters initially in a cohort of healthy men 40 years or older without voiding abnormalities. The model was then verified using retrospective analysis of urodynamic data from 822 older men with voiding dysfunction. Based on this analysis, measurements below the 25th percentile were associated with clinical indicators of detrusor underactivity. This finding provides an initial urodynamic measure that can be used to help differentiate detrusor underactivity from bladder outlet obstruction. Detrusor underactivity was associated with increased age, bladder capacity and post-void residual volume, and poorer voiding efficiency. These data can be used to help in the ongoing process of defining this complex clinical entity and as a predictive variable outcome measure in future research.