Advertisement

Neuro-Urology pp 207-231 | Cite as

Urinary Retention and Voiding Dysfunction

  • Dominique Malacarne Pape
  • Victor W. Nitti
Chapter

Abstract

The physiology of voiding is intricate and complex, and there is vast potential for disruption of normal voiding patterns. For adequate bladder emptying to take place, the bladder needs to generate a pressure of adequate strength and duration to overcome the resistance set by the outlet. Disruption in the generation of the bladder pressure required, or of the outlet to allow passage of urine, will result in incomplete bladder emptying. Underlying these pathophysiological processes is the gateway for proper development of new therapies. It is important to have a solid knowledge of terminology applied to the genitourinary tract for purposes of reporting results and developing treatment guidelines.

A thorough evaluation is crucial to properly diagnose patients with bladder-emptying disorder and to subsequently implement treatment strategies. Appropriate studies, including post-void residual, uroflow, labs, imaging, and, the gold standard, urodynamics, with or without fluoroscopy, are then added to a comprehensive workup to arrive at a diagnosis. Nomograms should be used when needed to help standardize the evaluation of patients, but in certain instances, evaluation of each individual case as a separate entity is of paramount importance. Patients should be thoroughly counseled regarding treatment options and potential risks and benefits associated with each. Lastly, patients at high risk for upper tract deterioration should be closely monitored and reevaluated periodically to reduce the incidence of dangerous long-term effects of incomplete bladder emptying.

Keywords

Urinary retention Incomplete bladder emptying Voiding dysfunction Detrusor underactivity Bladder outlet obstruction 

References

  1. 1.
    Fowler CJ, Griffiths D, deGroat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453–66.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Brucker BM, Nitti VW. Evaluation of urinary retention in women: pelvic floor dysfunction or primary bladder neck obstruction. Curr Bladder Dysfunct Rep. 2012;7:222–9.CrossRefGoogle Scholar
  3. 3.
    Nassau D, Gerber J, Weiss J. The prevalence and treatment of voiding dysfunction in the elderly. Curr Geriatr Rep. 2014;3:33–41.CrossRefGoogle Scholar
  4. 4.
    Irwin DE, et al. Population-based survey of urinary incontinence, overactive bladder, and other urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50:1306–15.CrossRefPubMedGoogle Scholar
  5. 5.
    Coyne K, Sexton C, Thompson C, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU. 2009;104(3):352–60.CrossRefGoogle Scholar
  6. 6.
    Coyne KS, Sexton CC, Bell JA, Thompson CL, Dmochowski R, Bavendam T, Chen CI, Quentin Clemens J. The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: results from OAB-POLL. Neurourol Urodyn. 2013;32:230–7.  https://doi.org/10.1002/nau.22295.CrossRefPubMedGoogle Scholar
  7. 7.
    Sadananda P, Vahabi B, Drake MJ. Bladder outlet physiology in the context of lower urinary tract dysfunction. Neurourol Urodyn. 2011;30:708–13.CrossRefPubMedGoogle Scholar
  8. 8.
    De Groat WC, Wickens C. Organization of the neural switching circuitry underlying reflex micturition. Acta Physiol (Oxf). 2013;207:66–84.CrossRefGoogle Scholar
  9. 9.
    Drake MJ, et al. Voiding dysfunction due to detrusor underactivity: an overview. Nat Rev Urol. 2014;11:454–64.CrossRefPubMedGoogle Scholar
  10. 10.
    Elbadawi A, Meyer S, Regnier CH. Role of ischemia in structural changes in the rabbit detrusor following partial bladder outlet obstruction: a working hypothesis and a biomechanical/structural model proposal. NeurourolUrodyn. 1989;8:151–62.Google Scholar
  11. 11.
    Malmqvist U, Arner A, Uvelius B. Contractile and cytoskeletal proteins in smooth muscle during hypertrophy and its reversal. Am J Physiol. 1991;63:86–93.Google Scholar
  12. 12.
    Sjuve R, Haase H, Morano I, et al. Contraction kinetics and myosin isoform composition in smooth muscle from hypertrophied rat urinary bladder. J Cell Biochem. 1996;63:86–93.CrossRefPubMedGoogle Scholar
  13. 13.
    Wolffenbuttel KP, de Jong BW, Scheepe JR, Kok DJ. Potential for recovery in bladder function after removing a urethral obstruction. NeurourolUrodyn. 2008;27:782–8.Google Scholar
  14. 14.
    Jock M, Leggett RE, Schuler C, et al. Effect of partial bladder outlet obstruction and reversal on rabbit bladder physiology and biochemistry: duration of recovery period and severity of function. BJU Int. 2014;114:946–54.CrossRefPubMedGoogle Scholar
  15. 15.
    Levin RM, Reed TP, Whitbeck C, Chichester P, Damaser M. Effect of strip length on the contractile dysfunction of bladder smooth muscle after partial outlet obstruction. Urology. 2005;66:659–64.CrossRefPubMedGoogle Scholar
  16. 16.
    Gilpin SA, Gilpin CJ, Dixon JS, et al. The effect of age on the autonomic innervation of the urinary bladder. Br J Urol. 1986;58:378–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Elbadawi A, Yalla SV, Resnick NM. Structural basis of geriatric voiding dysfunction. III Detrusor overactivity. J Urol. 1993;150:1681–95.CrossRefPubMedGoogle Scholar
  18. 18.
    Sugaya K, et al. Ascending and descending brainstem neuronal activity during cystometry in decerebrate cats. Neurourol Urodyn. 2003;22:343–50.CrossRefPubMedGoogle Scholar
  19. 19.
    Blok BF, Willesmsen AT, Holstege G. A PET study on brain control of micturition in humans. Brain. 1997;120:111–21.CrossRefGoogle Scholar
  20. 20.
    Yoshimura N, Chancellor MB, Andersson KE, Christ GJ. Recent advances in understanding the biology of diabetes-associated bladder complications and novel therapy. BJU Int. 2005;95:733–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Suskind AM, Smith PP. A new look at detrusor underactivity: impaired contractility versus afferent dysfunction. Curr Urol Rep. 2009;10:347–51.CrossRefPubMedGoogle Scholar
  22. 22.
    Drake MJ, Mills IW, Gillespie JI. Model of peripheral autonomous modules and a myovesical plexus in normal and overactive bladder function. Lancet. 2001;358:401–3.CrossRefPubMedGoogle Scholar
  23. 23.
    Haefliger JA, Tissieres P, Tawadros T, et al. Connexins 43 and 26 are differentially increased after rat bladder outlet obstruction. Exp Cell Res. 2002;274:216–25.CrossRefGoogle Scholar
  24. 24.
    Hampel C, Dolber PC, Smith MP, et al. Modulation of bladder alpha-1 adrenergic receptor subtype expression by bladder outlet obstruction. J Urol. 2002;167:1513–21.CrossRefPubMedGoogle Scholar
  25. 25.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A. The standardization of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. NeurourolUrodyn. 2002;21:167–78.Google Scholar
  26. 26.
    Wein A, Chapple C. Introduction and terminology. In: Chapple C, Wein A, Osman N, editors. Underactive bladder. Switzerland: Springer; 2017. p. ix–xiii.Google Scholar
  27. 27.
    Gajewski JB, Schurch B, Hamid R, et al. An International Continence Society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD). Neurourol Urodyn. 2018;37(3):1152–61.CrossRefPubMedGoogle Scholar
  28. 28.
    Wein AJ. Classification of neurogenic voiding dysfunction. J Urol. 1981;125:605.CrossRefPubMedGoogle Scholar
  29. 29.
    Osman N, et al. Detrusor underactivity and the underactive bladder: a new clinical entitity? A review of current terminology, definitions, epidemiology, aetiology and diagnosis. Eur Urol. 2014;65:389–98.CrossRefPubMedGoogle Scholar
  30. 30.
    Rosier P, Schaefer W, Lose G, et al. International continence society good urodynamic practices and terms 2016: urodynamics, uroflowmetry, cystometry, and pressure-flow study. NeurourolUrodyn. 2016;9999:1–18.Google Scholar
  31. 31.
    Araki I, Kitahara M, Oida T, Kuno S. Voiding dysfunction and Parkinson’s disease: urodynamic abnormalities and urinary symptoms. J Urol. 2000;164:1640–3.CrossRefPubMedGoogle Scholar
  32. 32.
    Campeau L, Soler R, Andersson KE. Bladder dysfunction and Parkinsonism: current pathophysiological understanding and management strategies. Curr Urol Rep. 2011;12:396–403.CrossRefPubMedGoogle Scholar
  33. 33.
    Burney TL, Senapati M, Desai S, et al. Acute cerebrovascular accident and lower urinary tract dysfunction: a prospective correlation of the site of brain injury with urodynamic findings. J Urol. 1996;156:1748–50.CrossRefPubMedGoogle Scholar
  34. 34.
    Manack A, Motsko SP, Haag-Molkenteller C, et al. Epidemiology and healthcare utilization of neurogenic bladder patients in a us claims database. NeurourolUrodyn. 2011;30:395–401.Google Scholar
  35. 35.
    Cruz CD, Coelho A, Antunes-Lopes T, et al. Biomarkers of spinal cord injury and ensuing bladder dysfunction. Adv Drug Deliv Rev. 2015;82–83:153–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Litwiller SE, Frohman EM, Zimmern PE. Multiple sclerosis and the urologist. J Urol. 1999;161:743–57.CrossRefPubMedGoogle Scholar
  37. 37.
    Andersson KE, Arner A. Urinary bladder contraction and relaxation: physiology and pathophysiology. Physiol Rev. 2004;84:935–86.CrossRefPubMedGoogle Scholar
  38. 38.
    Madersbacher S, Pycha A, Schatzl G, et al. The aging lower urinary tract: a comparative urodynamic study of men and women. Urology. 1998;51:206–12.CrossRefPubMedGoogle Scholar
  39. 39.
    Griffiths D, Tadic SD, Schaefer W, Resnick NM. Cerebral control of the bladder in normal and urge-incontinent women. Neuroimage. 2007;37:1–7.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Tyagi P, Smith PP, Kuchel GA, et al. Pathophysiology and animal modeling of underactive bladder. Int Urol Nephrol. 2014;46:S11–21.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Smith PP, Birder LA, Abrams P, Wein AJ, Chapple CR. Detrusor underactivity and the underactive bladder: symptoms, function, cause-what do we mean? ICI-RS think tank 2014. NeurourolUrodyn. 2016;35(2):312–7.  https://doi.org/10.1002/nau.22807. ReviewCrossRefGoogle Scholar
  42. 42.
    Zhu Q, et al. Role of ovarian hormones in the parthogenesis of impaired detrusor contractility: evidence in ovariectomized rodents. J Urol. 2001;166:1136–41.CrossRefPubMedGoogle Scholar
  43. 43.
    Sasaki K, Chancellor MB, Goins WF, et al. Gene therapy using replication-defective herpes simplex virus vectors expressing nerve growth factor in a rat model of diabetic cystopathy. Diabetes. 2004;53:2723–30.CrossRefPubMedGoogle Scholar
  44. 44.
    Madersbacher H, Cardozo L, Chapple C, Abrams P, Toozs-Hobson P, Young JS, Wyndaele JJ, deWachter S, Campeau L, Gajewski JB. What are the causes and consequences of bladder overdistention?:ICI-RS 2011. Neurourol Urodyn. 2012;31:317–21.CrossRefPubMedGoogle Scholar
  45. 45.
    Darrah DM, Griebling TL, Silverstein JH. Postoperative urinary retention. Anesthesiol Clin. 2009;27:465–84.CrossRefPubMedGoogle Scholar
  46. 46.
    Sivasankaran MV, Pham T, Divino CM. Incidence and risk factors for urinary retention following laparoscopic inguinal hernia repair. Am J Surg. 2014;2017:288–92.CrossRefGoogle Scholar
  47. 47.
    Yip SK, Sahota D, Pang MW, et al. Screening test model using duration of labor for the detection of postpartum urinary retention. NeurourolUrodyn. 2005;24:248–53.Google Scholar
  48. 48.
    Groutz A, Gordon D, Woman I, et al. Persistent postpartum urinary retention in contemporary obstetric practice. Definition, prevalence, and clinical implications. J Reprod Med. 2001;46:44–8.PubMedGoogle Scholar
  49. 49.
    Verhamme KM, Dieleman JP, Van Wijk MA, et al. Nonsteroidal anti-inflammatory drugs and increased risk of acute urinary retention. Arch Intern Med. 2005;165(13):1547–51.CrossRefPubMedGoogle Scholar
  50. 50.
    Mayo BC, Louie PK, Bohl DD, et al. Effects of intraoperative anesthetic medications on postoperative urinary retention after single-level lumber fusion. Spine. 2016;41(18):1441–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Boulis NM, Mian FS, Rodriguez D, et al. Urinary retention following routine neurosurgical spine procedures. Surg Neurol. 2001;55(1):23–7; discussion: 27–8CrossRefPubMedGoogle Scholar
  52. 52.
    Smith PJ, Hudak SJ, Scott F, Zhao LC, Morey A. Transcorporal artificial urinary sphincter cuff placement is associated with a higher risk of postoperative urinary retention. Can J Urol. 2013;20(3):6773–7.PubMedGoogle Scholar
  53. 53.
    Padmanabhan P, Nitti VW. Primary bladder neck obstruction in men, women, and children. Curr Urol Rep. 2007;8:379–84.CrossRefPubMedGoogle Scholar
  54. 54.
    Nitti VW, Lefkowitz G, Ficazzola M, Dixon CM. Lower urinary tract symptoms in young men: videourodynamic findings and correlation with noninvasive measures. J Urol. 2002;168(1):135–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Nitti VW, Ru LM, Gitlin J. Diagnosing bladder outlet obstruction in women. J Urol. 1999;161(5):1535–40.CrossRefPubMedGoogle Scholar
  56. 56.
    Kuo HC. Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology. 2005;66(5):1005–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Leadbetter GW, Leadbetter WF. Diagnosis and treatment of congenital bladder neck obstruction in children. N Engl J Med. 1959;260(13):633–7.CrossRefPubMedGoogle Scholar
  58. 58.
    Awad SA, Downie JW, Lywood DW, Young RA, Jarzylo SV. Sympathetic activity in the proximal urethra in patients with urinary obstruction. J Urol. 1976;115(5):545–7.CrossRefPubMedGoogle Scholar
  59. 59.
    Osman N, Chapple C. Fowler’s syndrome- a cause of unexplained urinary retention in young women? Nat Rev Urol. 2014;11:87–98.CrossRefPubMedGoogle Scholar
  60. 60.
    Fowler CJ, et al. Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome? BMJ. 1988;297:1436–8.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Lepor H, Machi G. Comparison of AUA symptom index in unselected males and females between fifty-five and seventy-nine years of age. Urology. 1993;42:36–41.CrossRefPubMedGoogle Scholar
  62. 62.
    Hsiao SM, Lin HH, Kuo HC. International prostate symptom score for assessing lower urinary tract dysfunction in women. Int Urogynecol J. 2013;24:263–7.CrossRefPubMedGoogle Scholar
  63. 63.
    Scarpero HM, Fiske J, Xue X, Nitti VW. American urological association symptom index for lower urinary tract symptoms in women: correlation with degree of bother and impact on quality of life. Urology. 2003;61(6):1118–22.CrossRefPubMedGoogle Scholar
  64. 64.
    Huang YH, Bih LI, Chen SL, et al. The accuracy of ultrasonic estimation of bladder volume: a comparison of portable and stationary equipment. Arch Phys Med Rehabil. 2004;85:138–41.CrossRefPubMedGoogle Scholar
  65. 65.
    Negro CL, Muir GH. Chronic urinary retention in men: how we define it, and how does it affect treatment outcome. BJU Int. 2012;110:1590–4.CrossRefPubMedGoogle Scholar
  66. 66.
    Spatafora S, Conti G, Perachino M, Casarico A, Mazzi G, Pappagallo GL, AURO. it BPH Guidelines Committee. Evidence-based guidelines for the management of lower urinary tract symptoms related to uncomplicated benign prostatic hyperplasia in Italy: updated summary. Curr Med Res Opin. 2007;23:1715–32.CrossRefPubMedGoogle Scholar
  67. 67.
    Nitti VW. Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction. Rev Urol. 2005;7(Suppl 6):S14–21.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Griffiths D, Hofner K, van Mastrigt R, Rollema HR, Spangberg A, Gleason D. Standardization of terminology of lower urinary tract function: pressure-flow studies of voiding, urethral resistance, and urethral obstruction. Neurourol Urodyn. 1997;16:1–18.CrossRefPubMedGoogle Scholar
  69. 69.
    Brucker B, Fong E, Shah S, Kelly C, Rosenblum N, Nitti V. Urodynamic differences between dysfunctional voiding and primary bladder neck obstruction in women. Urology. 2012;80:55–60.CrossRefPubMedGoogle Scholar
  70. 70.
    Han JH, Yu HS, Lee JY, et al. Simple modification of the bladder outlet obstruction index for better prediction of endoscopically-proven prostatic obstruction: a preliminary study. PLoS One. 2015;10:e0141745.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int. 1999;84:14–5.CrossRefPubMedGoogle Scholar
  72. 72.
    Oelke M, Rademakers K, van Koeveringe GA. Unraveling detrusor underactivity: development of a bladder outlet resistance-bladder contractility nomogram for adult male patients with lower urinary tract symptoms. NeurourolUrodyn. 2016;35:980–6.Google Scholar
  73. 73.
    Meier K, Padmanabhan P. Female bladder outlet obstruction: an update on diagnosis and management. Curr Opin Urol. 2016;26(4):334–41.CrossRefPubMedGoogle Scholar
  74. 74.
    Defreitas GA, Zimmern PE, Lemack GE, Shariat SF. Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology. 2004;64:675–9.CrossRefPubMedGoogle Scholar
  75. 75.
    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(2):361–9.CrossRefPubMedGoogle Scholar
  76. 76.
    Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. NeurourolUrodyn. 2000;19:553–64.Google Scholar
  77. 77.
    Choi YS, Kim JC, Lee KS, Seo JT, Kim HJ, Yoo TK, Lee JB, Choo MS, Lee JG, Lee JY. Analysis of female voiding dysfunction: a prospective, multi-center study. Int Urol Nephrol. 2013;45:989–94.CrossRefPubMedGoogle Scholar
  78. 78.
    Stoffel JT, Peterson AC, Sandhu JS, Suskind AM, Wei JT, LIghtner DJ. AUA white paper: non-neurogenic chronic urinary retention: consensus definition, treatment algorithm and outcome endpoints. J Urol. 2017;198(1):153–60.CrossRefPubMedGoogle Scholar
  79. 79.
    Apfel SC. Nerve growth factor administration protects against experimental diabetic sensory neuropathy. Brain Res. 1994;634:7–12.CrossRefPubMedGoogle Scholar
  80. 80.
    Garrett NE. Alpha-lipoic acid corrects neuropeptide deficits in diabetic rats via induction of trophic support. Neurosci Lett. 1997;222:191–4.CrossRefPubMedGoogle Scholar
  81. 81.
    Lourenco T, Pickard R, Vale L, Grant A, Fraser C, MacLennan G, N’Dow J. Minimally invasive treatments for benign prostatic enlargement: systematic review of randomized controlled trials. BMJ. 2008;337(a1662):1–8.Google Scholar
  82. 82.
    Harris C, et al. National variation in urethroplasty cost and predictors of extreme cost: a cost analysis with policy implications. Urology. 2016;94:246–54.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Gomelsky A, Scapero HM, Dmochowski RR. Sling surgery for stress urinary incontinence in the female: what surgery, which material? AUA Update Ser. 2003;22(34):266–76.Google Scholar
  84. 84.
    Rardin CR, Rosenblatt PL, Kohli N, Miklos JR, Heit M, Lucente VR. Release of tension-free vaginal tape for the treatment of refractory post-operative voiding dysfunction. Obstet Gynecol. 2002;100:898–902.PubMedGoogle Scholar
  85. 85.
    Viereck V, Rautenberg O, Kociszeski J, et al. Midurethral sling incision: indications and outcomes. Int Urogynecol J. 2013;24(4):645–53.CrossRefPubMedGoogle Scholar
  86. 86.
    Pedraza R, Nieto J, Ibarra S, Haas E. Pelvic muscle rehabilitation: a standardized protocol for pelvic floor dysfunction. Adv Urol. 2014;2014:487436.  https://doi.org/10.1155/2014/487436.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Urology, Female Pelvic Medicine and Reconstructive SurgeryNYU Langone Medical CenterNew YorkUSA

Personalised recommendations