Investig Clin Urol.  2017 Dec;58(Suppl 2):S90-S98. 10.4111/icu.2017.58.S2.S90.

Current pharmacological and surgical treatment of underactive bladder

• Kim DK

• KMID: 2397985
• DOI: http://doi.org/10.4111/icu.2017.58.S2.S90

Abstract

Generally accepted guidelines are not yet available on the management of underactive bladder (UAB). Although the natural history of UAB is still not fully understood, observation may be an acceptable management option in patients with tolerable lower urinary tract symptoms and little risk of upper urinary tract damage. If needed, scheduled and double voiding may be recommended as an effective and safe add-on therapy. Parasympathomimetics have been widely used for the management of UAB, but the evidence does not support clinical benefit. The efficacy of alpha-blockers has also not yet been clearly demonstrated. However, selective alpha-blockers may help to enhance voiding efficiency and to decrease possible upper tract damage. Sacral neuromodulation is a surgical option for nonobstructive UAB approved by the Food and Drug Administration. However, the response rate of test stimulation is not high and the efficacy of permanent implants does not always coincide with that of test stimulation. Although surgery to reduce outlet resistance may be a viable option in UAB with presumed obstruction, surgery seems to have little role in those without obstruction. Latissimus dorsi detrusor myoplasty has shown promising results in restoring voluntary voiding in selected patients. The procedure requires a multidisciplinary team approach of urologists and plastic reconstructive experts. In summary, current treatments of UAB remain unsatisfactory. The multifactorial nature of UAB pathogenesis complicates the appropriate management for each patient. Future research to establish a more clinically relevant definition of UAB will be required to open new era of UAB management.

Keyword

Drug therapy; Operative surgical procedures; Urinary bladder; Urinary bladder, neurogenic

MeSH Terms

Drug Therapy
Humans
Lower Urinary Tract Symptoms
Natural History
Parasympathomimetics
Plastics
Superficial Back Muscles
Surgical Procedures, Operative
United States Food and Drug Administration
Urinary Bladder*
Urinary Bladder, Neurogenic
Urinary Tract
Parasympathomimetics
Plastics

Reference

1. Andersson KE. The many faces of impaired bladder emptying. Curr Opin Urol. 2014; 24:363–369. PMID: 24752226.

2. Andersson KE. Detrusor underactivity/underactive bladder: new research initiatives needed. J Urol. 2010; 184:1829–1830. PMID: 20846686.

3. Miyazato M, Yoshimura N, Chancellor MB. The other bladder syndrome: underactive bladder. Rev Urol. 2013; 15:11–22. PMID: 23671401.

4. Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated detrusor underactivity. BJU Int. 2005; 96:1295–1300. PMID: 16287448.

5. Consortium for Spinal Cord Medicine. Outcomes following traumatic spinal cord injury: clinical practice guidelines for health-care professionals. J Spinal Cord Med. 2000; 23:289–316. PMID: 17536300.

6. El-Masri WS, Chong T, Kyriakider AE, Wang D. Long-term follow-up study of outcomes of bladder management in spinal cord injury patients under the care of the Midlands Centre for Spinal Injuries in Oswestry. Spinal Cord. 2012; 50:14–21. PMID: 21808256.

7. Aquilonius SM, Hartvig P. Clinical pharmacokinetics of cholinesterase inhibitors. Clin Pharmacokinet. 1986; 11:236–249. PMID: 3524957.

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. PMID: 17233798.

9. Taylor P. Anticholinesterase agents. Goodman LD, Gilman A, Brunton LL, Lazo JS, Parker KL. Goodman and Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw-Hill;2006. p. 211–212.

10. Fleming AR. The use of urecholine in the prevention of postpartum urinary retention; final report. Am J Obstet Gynecol. 1957; 74:569–571. PMID: 13458255.

11. Barrett DM. The effect of oral bethanechol chloride on voiding in female patients with excessive residual urine: a randomized double-blind study. J Urol. 1981; 126:640–642. PMID: 6117662.

12. Shah PJ, Abrams PH, Choa RG, Ashken MH, Gaches CG, Green NA, et al. Distigmine bromide and post-prostatectomy voiding. Br J Urol. 1983; 55:229–232. PMID: 6132645.

13. Gottesman L, Milsom JW, Mazier WP. The use of anxiolytic and parasympathomimetic agents in the treatment of postoperative urinary retention following anorectal surgery. A prospective, randomized, double-blind study. Dis Colon Rectum. 1989; 32:867–870. PMID: 2571469.

14. Savona-Ventura C, Grech ES, Saliba I. Pharmacological measures to prevent post-operative urinary retention; a prospective randomized study. Eur J Obstet Gynecol Reprod Biol. 1991; 41:225–229. PMID: 1682174.

15. Kemp B, Kitschke HJ, Goetz M, Heyl W. Prophylaxis and treatment of bladder dysfunction after Wertheim-Meigs operation: the positive effect of early postoperative detrusor stimulation using the cholinergic drug betanecholchloride. Int Urogynecol J Pelvic Floor Dysfunct. 1997; 8:138–141. PMID: 9449585.

16. Burger DH, Kappetein AP, Boutkan H, Breslau PJ. Prevention of urinary retention after general surgery: a controlled trial of carbachol/diazepam versus alfusozine. J Am Coll Surg. 1997; 185:234–236. PMID: 9291399.

17. Hindley RG, Brierly RD, Thomas PJ. Prostaglandin E2 and bethanechol in combination for treating detrusor underactivity. BJU Int. 2004; 93:89–92. PMID: 14678375.

18. 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. PMID: 14706012.

19. Riedl CR, Stephen RL, Daha LK, Knoll M, Plas E, Pflüger H. Electromotive administration of intravesical bethanechol and the clinical impact on acontractile detrusor management: introduction of a new test. J Urol. 2000; 164:2108–2111. PMID: 11061937.

20. De Wachter S, Van Meel TD, Wyndaele JJ. Study of the afferent nervous system and its evaluation in women with impaired detrusor contractility treated with bethanechol. Urology. 2003; 62:54–58. PMID: 12837422.

21. Levin RM, Longhurst PA, Barasha B, McGuire EJ, Elbadawi A, Wein AJ. Studies on experimental bladder outlet obstruction in the cat: long-term functional effects. J Urol. 1992; 148:939–943. PMID: 1512863.

22. Haugaard N, Potter L, Wein AJ, Levin RM. Effect of partial obstruction of the rabbit urinary bladder on malate dehydrogenase and citrate synthase activity. J Urol. 1992; 147:1391–1393. PMID: 1485895.

23. Moon KH, Park CH, Jung HC, Oh TH, Kim JS, Kim DY. A 12-week, open label, multi-center study to evaluate the clinical efficacy and safety of silodosin on voiding dysfunction in patients with neurogenic bladder. Low Urin Tract Symptoms. 2015; 7:27–31. PMID: 26663648.

24. Andersson KE, Nomiya M, Yamaguchi O. Chronic pelvic ischemia: contribution to the pathogenesis of lower urinary tract symptoms (LUTS): a new target for pharmacological treatment? Low Urin Tract Symptoms. 2015; 7:1–8. PMID: 26663644.

25. Nomiya M, Andersson KE, Yamaguchi O. Chronic bladder ischemia and oxidative stress: new pharmacotherapeutic targets for lower urinary tract symptoms. Int J Urol. 2015; 22:40–46. PMID: 25339506.

26. Abrams P, Amarenco G, Bakke A, Buczyński A, Castro-Diaz D, Harrison S, et al. Tamsulosin: efficacy and safety in patients with neurogenic lower urinary tract dysfunction due to suprasacral spinal cord injury. J Urol. 2003; 170(4 Pt 1):1242–1251. PMID: 14501734.

27. Chang SJ, Chiang IN, Yu HJ. The effectiveness of tamsulosin in treating women with voiding difficulty. Int J Urol. 2008; 15:981–985. PMID: 18721208.

28. Andersson KE, Wein AJ. Pharmacology of the lower urinary tract: basis for current and future treatments of urinary incontinence. Pharmacol Rev. 2004; 56:581–631. PMID: 15602011.

29. Andersson KE, Henriksson L, Ulmsten U. Effects of prostaglandin E2 applied locally on intravesical and intraurethral pressures in women. Eur Urol. 1978; 4:366–369. PMID: 568550.

30. Desmond AD, Bultitude MI, Hills NH, Shuttleworth KE. Clinical experience with intravesical prostaglandin E2. A prospective study of 36 patients. Br J Urol. 1980; 52:357–366. PMID: 7427009.

31. Wagner G, Husslein P, Enzelsberger H. Is prostaglandin E2 really of therapeutic value for postoperative urinary retention? Results of a prospectively randomized double-blind study. Am J Obstet Gynecol. 1985; 151:375–379. PMID: 3881968.

32. Doi Y, Murasaki O, Kaibara M, Uezono Y, Hayashi H, Yano K, et al. Characterization of functional effects of Z-338, a novel gastroprokinetic agent, on the muscarinic M1, M2, and M3 receptors expressed in Xenopus oocytes. Eur J Pharmacol. 2004; 505:31–35. PMID: 15556134.

33. Sugimoto K, Akiyama T, Shimizu N, Matsumura N, Hayashi T, Nishioka T, et al. A pilot study of acotiamide hydrochloride hydrate in patients with detrusor underactivity. Res Rep Urol. 2015; 7:81–83. PMID: 26056686.

34. Dénes J, Léb J. Electrostimulation of the neuropathic bladder. J Pediatr Surg. 1975; 10:245–247. PMID: 1091723.

35. Primus G, Kramer G, Pummer K. Restoration of micturition in patients with acontractile and hypocontractile detrusor by transurethral electrical bladder stimulation. Neurourol Urodyn. 1996; 15:489–497. PMID: 8857617.

36. Lombardi G, Celso M, Mencarini M, Nelli F, Del Popolo G. Clinical efficacy of intravesical electrostimulation on incomplete spinal cord patients suffering from chronic neurogenic non-obstructive retention: a 15-year single centre retrospective study. Spinal Cord. 2013; 51:232–237. PMID: 23147136.

37. Leng WW, Chancellor MB. How sacral nerve stimulation neuromodulation works. Urol Clin North Am. 2005; 32:11–18. PMID: 15698871.

38. Lombardi G, Musco S, Celso M, Ierardi A, Nelli F, Del Corso F, et al. Intravesical electrostimulation versus sacral neuromodulation for incomplete spinal cord patients suffering from neurogenic non-obstructive urinary retention. Spinal Cord. 2013; 51:571–578. PMID: 23628893.

39. Lombardi G, Musco S, Celso M, Del Corso F, Del Popolo G. Sacral neuromodulation for neurogenic non-obstructive urinary retention in incomplete spinal cord patients: a ten-year follow-up single-centre experience. Spinal Cord. 2014; 52:241–245. PMID: 24394604.

40. Jonas U, Fowler CJ, Chancellor MB, Elhilali MM, Fall M, Gajewski JB, et al. Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol. 2001; 165:15–19. PMID: 11125353.

41. 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. PMID: 16461081.

42. Sokhal AK, Sinha RJ, Purkait B, Singh V. Transurethral resection of prostate in benign prostatic enlargement with underactive bladder: a retrospective outcome analysis. Urol Ann. 2017; 9:131–135. PMID: 28479762.

43. 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. PMID: 28361512.

44. 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. PMID: 26879733.

45. Cho MC, Park J, Kim JK, Cho SY, Jeong H, Oh SJ, et al. Can preoperative detrusor underactivity influence surgical outcomes of 120 W HPS vaporization of the prostate (PVP) or holmium laser enucleation of the prostate (HoLEP)? A serial 3-year follow-up study. Neurourol Urodyn. 2017; 6. 09. DOI: 10.1002/nau.23317. [Epub].

46. 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. PMID: 27450935.

47. Yu Z, Li J, Li Z, Hou R. Photoselective vaporization of the prostate and simultaneous suprapubic cystostomy for the treatment of benign prostatic hyperplasia in patients with mild to severe detrusor underactivity. Urol Int. 2015; 95:269–275. PMID: 26138113.

48. Jhang JF, Jiang YH, Kuo HC. Transurethral incision of the bladder neck improves voiding efficiency in female patients with detrusor underactivity. Int Urogynecol J. 2014; 25:671–676. PMID: 24288115.

49. Jhang JF, Jiang YH, Lee CL, Kuo HC. Long-term follow up and predictive factors for successful outcome of transurethral incision of the bladder neck in women with detrusor underactivity. J Formos Med Assoc. 2016; 115:807–813. PMID: 26375777.

50. Phelan MW, Franks M, Somogyi GT, Yokoyama T, Fraser MO, Lavelle JP, et al. Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. J Urol. 2001; 165:1107–1110. PMID: 11257648.

51. Mokhless I, Gaafar S, Fouda K, Shafik M, Assem A. Botulinum A toxin urethral sphincter injection in children with nonneurogenic neurogenic bladder. J Urol. 2006; 176(4 Pt 2):1767–1770. PMID: 16945643.

52. Masumori N, Furuya R, Tanaka Y, Furuya S, Ogura H, Tsukamoto T. The 12-year symptomatic outcome of transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the urodynamic findings before surgery. BJU Int. 2010; 105:1429–1433. PMID: 19863522.

53. Al-Hayek S, Thomas A, Abrams P. Natural history of detrusor contractility--minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor. Scand J Urol Nephrol Suppl. 2004; (215):101–108. PMID: 15545204.

54. 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. PMID: 15049984.

55. Kim M, Jeong CW, Oh SJ. Effect of preoperative urodynamic detrusor underactivity on transurethral surgery for benign prostatic hyperplasia: a systematic review and meta-analysis. J Urol. 2017; 7. 29. [Epub]. pii: S0022-5347(17)77237-0. DOI: 10.1016/j.juro.2017.07.079.

56. 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. PMID: 22216394.

57. Weir J, Jaques PF. Large-capacity bladder. A urodynamic survey. Urology. 1974; 4:544–548. PMID: 4428554.

58. Chancellor MB, Rivas DA, Bourgeois IM. Laplace's law and the risks and prevention of bladder rupture after enterocystoplasty and bladder autoaugmentation. Neurourol Urodyn. 1996; 15:223–233. PMID: 8732989.

59. Yoshimura N, Chancellor MB. Physiology and pharmacology of the bladder and urethra. In : Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 10th. Philadelphia (PA): Elsevier/Saunders;2012. p. 1786–1833.

60. Stewart HH. The surgical treatment of severe chronic retention without large diverticula. Br J Urol. 1966; 38:685–695. PMID: 5958051.

61. Zoedler D. Surgical treatment of bladder atony. Z Urol. 1964; 57:743–748. PMID: 14318438.

62. Klarskov P, Holm-Bentzen M, Larsen S, Gerstenberg T, Hald T. Partial cystectomy for the myogenic decompensated bladder with excessive residual urine. Urodynamics, histology and 2-13 years follow-up. Scand J Urol Nephrol. 1988; 22:251–256. PMID: 3238329.

63. Bukowski TP, Perlmutter AD. Reduction cystoplasty in the prune belly syndrome: a long-term followup. J Urol. 1994; 152(6 Pt 1):2113–2116. PMID: 7966698.

64. Kinn AC. The lazy bladder: appraisal of surgical reduction. Scand J Urol Nephrol. 1985; 19:93–99. PMID: 4059883.

65. Zhang YH, Shao QA, Wang JM. Enveloping the bladder with displacement of flap of the rectus abdominis muscle for the treatment of neurogenic bladder. J Urol. 1990; 144:1194–1195. PMID: 2146404.

66. Blackburn NE, Mc Veigh JG, Mc Caughan E, Wilson IM. The musculoskeletal consequences of breast reconstruction using the latissimus dorsi muscle for women following mastectomy for breast cancer: a critical review. Eur J Cancer Care (Engl). 2017; 2. 10. [Epub]. DOI: 10.1111/ecc.12664.

67. Dumcius A, Chekanov V, Vysockas V. Current status of cardiomyoplasty as surgical alternative for end-stage heart failure. Medicina (Kaunas). 2003; 39:815–822. PMID: 14515042.

68. Stenzl A, Ninkovic M, Willeit J, Hess M, Feichtinger H, Schwabegger A, et al. Free neurovascular transfer of latissimus dorsi muscle to the bladder. I. Experimental studies. J Urol. 1997; 157:1103–1108. PMID: 9072552.

69. Stenzl A, Ninkovic M, Kölle D, Knapp R, Anderl H, Bartsch G. Restoration of voluntary emptying of the bladder by transplantation of innervated free skeletal muscle. Lancet. 1998; 351:1483–1485. PMID: 9605805.

70. Ninkovic M, Stenzl A, Schwabegger A, Bartsch G, Prosser R, Ninkovic M. Free neurovascular transfer of latisstmus dorsi muscle for the treatment of bladder acontractility: II. Clinical results. J Urol. 2003; 169:1379–1383. PMID: 12629366.

71. Gakis G, Ninkovic M, van Koeveringe GA, Raina S, Sturtz G, Rahnama'i MS, et al. Functional detrusor myoplasty for bladder acontractility: long-term results. J Urol. 2011; 185:593–599. PMID: 21168866.