Investig Clin Urol.  2017 Dec;58(Suppl 2):S75-S81. 10.4111/icu.2017.58.S2.S75.

Clinical implications of underactive bladder

• Ko KJ
• Lee CU
• Lee KS

• KMID: 2397983
• DOI: http://doi.org/10.4111/icu.2017.58.S2.S75

Abstract

Underactive bladder (UAB) is a common urologic condition but a complex disease that causes troublesome lower urinary tract symptoms. Currently, management of UAB remains unsatisfactory. Also, many urological diseases can be combined with UAB. In these combined cases, the treatment results may be affected by UAB component. This review focuses on the clinical implications of UAB in patients with common urologic conditions, including bladder outlet obstruction, overactive bladder syndrome and stress urinary incontinence.

Keyword

Lower urinary tract symptoms; Overactive urinary bladder; Urinary incontinence

MeSH Terms

Humans
Lower Urinary Tract Symptoms
Urinary Bladder Neck Obstruction
Urinary Bladder*
Urinary Bladder, Overactive
Urinary Incontinence
Urologic Diseases

Figure

• 

  Fig. 1 Common urologic conditions that overlap with detrusor underactivity. DOIC, detrusor overactivity and impaired contractility.

Reference

1. Miyazato M, Yoshimura N, Chancellor MB. The other bladder syndrome: underactive bladder. Rev Urol. 2013; 15:11–22.

2. Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V, et al. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2014; 65:389–398.

3. Chapple CR, Osman NI. Crystallizing the definition of underactive bladder syndrome, a common but under-recognized clinical entity. Low Urin Tract Symptoms. 2015; 7:71–76.

4. Aggarwal H, Zimmern PE. Underactive Bladder. Curr Urol Rep. 2016; 17:17.

5. Dewulf K, Abraham N, Lamb LE, Griebling TL, Yoshimura N, Tyagi P, et al. Addressing challenges in underactive bladder: recommendations and insights from the Congress on Underactive Bladder (CURE-UAB). Int Urol Nephrol. 2017; 49:777–785.

6. Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM, et al. Prevalence and clinical features of detrusor underactivity among elderly with lower urinary tract symptoms: a comparison between men and women. Korean J Urol. 2012; 53:342–348.

7. Andersson KE. Detrusor underactivity/underactive bladder: new research initiatives needed. J Urol. 2010; 184:1829–1830.

8. Barendrecht MM, Oelke M, Laguna MP, Michel MC. Is the use of parasympathomimetics for treating an underactive urinary bladder evidence-based? BJU Int. 2007; 99:749–752.

9. Yamanishi T, Yasuda K, Kamai T, Tsujii T, Sakakibara R, Uchiyama T, et al. Combination of a cholinergic drug and an alpha-blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor. Int J Urol. 2004; 11:88–96.

10. Abraham N, Goldman HB. An update on the pharmacotherapy for lower urinary tract dysfunction. Expert Opin Pharmacother. 2015; 16:79–93.

11. Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013; 64:118–140.

12. Abrams PH. Prostatism and prostatectomy: the value of urine flow rate measurement in the preoperative assessment for operation. J Urol. 1977; 117:70–71.

13. Doll HA, Black NA, McPherson K, Flood AB, Williams GB, Smith JC. Mortality, morbidity and complications following transurethral resection of the prostate for benign prostatic hypertrophy. J Urol. 1992; 147:1566–1573.

14. Seki N, Kai N, Seguchi H, Takei M, Yamaguchi A, Naito S. Predictives regarding outcome after transurethral resection for prostatic adenoma associated with detrusor underactivity. Urology. 2006; 67:306–310.

15. Rollema HJ, Van Mastrigt R. Improved indication and followup in transurethral resection of the prostate using the computer program CLIM: a prospective study. J Urol. 1992; 148:111–115. discussion 5–6.

16. Van Mastrigt R, Rollema HJ. The prognostic value of bladder contractility in transurethral resection of the prostate. J Urol. 1992; 148:1856–1860.

17. Javle P, Jenkins SA, Machin DG, Parsons KF. Grading of benign prostatic obstruction can predict the outcome of transurethral prostatectomy. J Urol. 1998; 160:1713–1717.

18. Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up. BJU Int. 2004; 93:745–750.

19. Tanaka Y, Masumori N, Itoh N, Furuya S, Ogura H, Tsukamoto T. Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity? Int J Urol. 2006; 13:1398–1404.

20. Han DH, Jeong YS, Choo MS, Lee KS. The efficacy of transurethral resection of the prostate in the patients with weak bladder contractility index. Urology. 2008; 71:657–661.

21. Ou R, Pan C, Chen H, Wu S, Wei X, Deng X, et al. Urodynamically diagnosed detrusor hypocontractility: should transurethral resection of the prostate be contraindicated. Int Urol Nephrol. 2012; 44:35–39.

22. Zhang X, Shen P, He Q, Yin X, Chen Z, Gui H, et al. Different lasers in the treatment of benign prostatic hyperplasia: a network meta-analysis. Sci Rep. 2016; 6:23503.

23. Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2004; 172:1926–1929.

24. Li S, Zeng XT, Ruan XL, Weng H, Liu TZ, Wang X, et al. Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis. PLoS One. 2014; 9:e101615.

25. Choi SW, Choi YS, Bae WJ, Kim SJ, Cho HJ, Hong SH, et al. 120 W greenlight HPS laser photoselective vaporization of the prostate for treatment of benign prostatic hyperplasia in men with detrusor underactivity. Korean J Urol. 2011; 52:824–828.

26. Mitchell CR, Mynderse LA, Lightner DJ, Husmann DA, Krambeck AE. Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility: results of a prospective trial. Urology. 2014; 83:428–432.

27. Cho MC, Ha SB, Park J, Son H, Oh SJ, Kim SW, et al. Impact of detrusor underactivity on surgical outcomes of laser prostatectomy: comparison in serial 12-month follow-up outcomes between potassium-titanyl-phosphate photoselective vaporization of the prostate (PVP) and holmium laser enucleation of the prostate (HoLEP). Urology. 2016; 91:158–166.

28. Woo MJ, Ha YS, Lee JN, Kim BS, Kim HT, Kim TH, et al. Comparison of surgical outcomes between holmium laser enucleation and transurethral resection of the prostate in patients with detrusor underactivity. Int Neurourol J. 2017; 21:46–52.

29. Lomas DJ, Krambeck AE. Long-term efficacy of holmium laser enucleation of the prostate in patients with detrusor underactivity or acontractility. Urology. 2016; 97:208–211.

30. Gammie A, Kaper M, Dorrepaal C, Kos T, Abrams P. Signs and symptoms of detrusor underactivity: an analysis of clinical presentation and urodynamic tests from a large group of patients undergoing pressure flow studies. Eur Urol. 2016; 69:361–369.

31. Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. JAMA. 1987; 257:3076–3081.

32. Abarbanel J, Marcus EL. Impaired detrusor contractility in community-dwelling elderly presenting with lower urinary tract symptoms. Urology. 2007; 69:436–440.

33. Liu S, Chan L, Tse V. Clinical outcome in male patients with detrusor overactivity with impaired contractility. Int Neurourol J. 2014; 18:133–137.

34. Wagg A, Nitti VW, Kelleher C, Castro-Diaz D, Siddiqui E, Berner T. Oral pharmacotherapy for overactive bladder in older patients: mirabegron as a potential alternative to antimuscarinics. Curr Med Res Opin. 2016; 32:621–638.

35. Chapple CR, Siddiqui E. Mirabegron for the treatment of overactive bladder: a review of efficacy, safety and tolerability with a focus on male, elderly and antimuscarinic poor-responder populations, and patients with OAB in Asia. Expert Rev Clin Pharmacol. 2017; 10:131–151.

36. Dowson C, Watkins J, Khan MS, Dasgupta P, Sahai A. Repeated botulinum toxin type A injections for refractory overactive bladder: medium-term outcomes, safety profile, and discontinuation rates. Eur Urol. 2012; 61:834–839.

37. Mohee A, Khan A, Harris N, Eardley I. Long-term outcome of the use of intravesical botulinum toxin for the treatment of overactive bladder (OAB). BJU Int. 2013; 111:106–113.

38. Wang CC, Lee CL, Kuo HC. Efficacy and safety of intravesical onabotulinumtoxinA injection in patients with detrusor hyperactivity and impaired contractility. Toxins (Basel). 2016; 8(3):DOI: 10.3390/toxins8030082.

39. Chancellor MB, Chartier-Kastler EJ. Principles of sacral nerve stimulation (SNS) for the treatment of bladder and urethral sphincter dysfunctions. Neuromodulation. 2000; 3:16–26.

40. Hennessey DB, Hoag N, Gani J. Sacral neuromodulation for detrusor hyperactivity with impaired contractility. Neurourol Urodyn. 2017; 03. 27. [Epub]. DOI: 10.1002/nau.23255.

41. Chancellor MB. The overactive bladder progression to underactive bladder hypothesis. Int Urol Nephrol. 2014; 46:Suppl 1. S23–S27.

42. Lukacz ES, Luber KM, Nager CW. The effects of the tension-free vaginal tape on voiding function: a prospective evaluation. Int Urogynecol J Pelvic Floor Dysfunct. 2004; 15:32–38. discussion 8.

43. Hong B, Park S, Kim HS, Choo MS. Factors predictive of urinary retention after a tension-free vaginal tape procedure for female stress urinary incontinence. J Urol. 2003; 170:852–856.

44. Cetinel B, Demirkesen O, Onal B, Akkus E, Alan C, Can G. Are there any factors predicting the cure and complication rates of tension-free vaginal tape. Int Urogynecol J Pelvic Floor Dysfunct. 2004; 15:188–193.

45. Salin A, Conquy S, Elie C, Touboul C, Parra J, Zerbib M, et al. Identification of risk factors for voiding dysfunction following TVT placement. Eur Urol. 2007; 51:782–787. discussion 7.

46. Cho ST, Song HC, Song HJ, Lee YG, Kim KK. Predictors of postoperative voiding dysfunction following transobsturator sling procedures in patients with stress urinary incontinence. Int Neurourol J. 2010; 14:26–33.

47. Kuo HC. Effect of detrusor function on the therapeutic outcome of a suburethral sling procedure using a polypropylene sling for stress urinary incontinence in women. Scand J Urol Nephrol. 2007; 41:138–143.

48. Kim SJ, Kim JC. Influence of preoperative detrusor underactivity on the continence rate and satisfaction after midurethral sling patient with stress urinary incontinence. LUTS: Lower Urinary Tract Symptoms. 2010; 2:95–99.

49. Jo DG, Yang SA, Seo JT. Effects of transobturator adjustable tape sling procedure on the therapeutic outcome in patients with stress urinary incontinence and detrusor underactivity. Int Neurourol J. 2010; 14:20–25.

50. Lee SY, Lee YS, Lee HN, Choo MS, Lee JG, Kim HG, et al. Transobturator adjustable tape for severe stress urinary incontinence and stress urinary incontinence with voiding dysfunction. Int Urogynecol J. 2011; 22:341–346.

51. Ko KJ, Suh YS, Sung HH, Ryu GH, Lee M, Lee KS. Assessing the readjustable sling procedure (Remeex System) for female stress urinary incontinence with detrusor underactivity. Int Neurourol J. 2017; 21:116–120.