Korean J Urol.  2012 May;53(5):342-348.

Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women

• Jeong SJ
• Kim HJ
• Lee YJ
• Lee JK
• Lee BK
• Choo YM
• Oh JJ
• Lee SC
• Jeong CW
• Yoon CY
• Hong SK
• Byun SS
• Lee SE

Abstract

PURPOSE
To identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS).
MATERIALS AND METHODS
We reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) < or =12 ml/s combined with a detrusor pressure at Qmax < or =10 cmH2O for men and women, respectively.
RESULTS
Of the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU.
CONCLUSIONS
DU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.

Keyword

Aged; Prevalence; Urinary bladder; Urination disorders; Urodynamics

MeSH Terms

Aged
Compliance
Female
Humans
Incidence
Lower Urinary Tract Symptoms
Male
Prevalence
Urinary Bladder
Urinary Bladder Neck Obstruction
Urinary Incontinence
Urinary Tract
Urination Disorders
Urodynamics

Figure

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  FIG. 1 Prevalence of detrusor underactivity by age group. Prevalence of detrusor underactivity increased with age (p=0.053 and 0.002 in men and women, respectively).

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  FIG. 2 Prevalence of detrusor underactivity, detrusor overactivity, bladder outlet obstruction, and urodynamic stress urinary incontinence by age group. (A) In men, prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum but prevalence of detrusor underactivity (DU) and detrusor overactivity (DO) increased with age. (B) In women, prevalence of urodynamic stress urinary incontinence (USUI) decreased and the prevalence of DU, DO, BOO increased with age.

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  FIG. 3 Combined urodynamic diagnosis in the subjects with detrusor underactivity. M, men; F, women; DU, detrusor underactivity; DO, detrusor overactivity; BOO, bladder outlet obstruction; USUI, urodynamic stress urinary incontinence.

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