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Management of Patients with Detrusor Hyperactivity with Impaired Contractility

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Abstract

Purpose of Review

Detrusor hyperactivity and impaired contractility (DHIC) is a common condition seen in elderly patients who suffered from lower urinary tract symptoms. Hypothetical pathogenesis and debatable definition of diagnosis may have caused difficulties in developing effective treatments through the past decades. In this review, we aim to discuss currently available treatments of DHIC.

Recent Findings

Mirabegron was an effective treatment option with subjective symptom improvement and reduced post-void residual volume at 6 months. Intravesical injection of onabotulinumtoxinA improved overactive bladder (OAB) symptoms component subjectively but shorter efficacy duration was noted. Sacral neuromodulation is a promising treatment for both components of DHIC, including OAB and non-obstructive urinary retention. Novel agent TAC-302 may have a potential role on treating the detrusor underactivity (DU) component in patients with DHIC.

Summary

Behavioral therapies and intermittent catheterization were the rare available treatment options traditionally. Titrated anticholinergics and intravesical onabotulinumtoxinA injection can be suitable in lower risk patients. Mirabegron and sacral neuromodulation have been recently reported to be safe and effective treatment modalities. Further research on confirmation of current therapies, combination or sequential choices, and exploration of novel agents is needed.

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Authors and Affiliations

  1. Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin, 640, Taiwan

    Fan-Ching Hung

  2. Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, 970, Taiwan

    Hann-Chorng Kuo

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Correspondence to Hann-Chorng Kuo.

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Hung, FC., Kuo, HC. Management of Patients with Detrusor Hyperactivity with Impaired Contractility. Curr Bladder Dysfunct Rep 18, 280–284 (2023). https://doi.org/10.1007/s11884-023-00721-7

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