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Updates of underactive bladder: a review of the recent literature

  • Urology - Review
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Abstract

Underactive bladder (UAB) is a major component of lower urinary tract symptoms. The physiopathology mechanisms underlying UAB include detrusor underactivity, acontractile detrusor, and reduced or absent bladder sensation. UAB can influence lower and upper urinary tract function and lead to serious consequences; however, the symptom syndrome is poorly understood and incompletely researched at present. Moreover, there is no agreement among authorities regarding the terminology, definition, epidemiology, classification, risk factors, animal model, pathogenesis, diagnosis, and treatment of UAB. In this review, we discuss the current terminology, epidemiology, physiopathology, evaluation, and management of UAB.

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References

  1. Abrams P et al (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol 187(1):116–126

    Article  PubMed  Google Scholar 

  2. Chapple CR et al (2015) The underactive bladder: a new clinical concept? Eur Urol 68(3):351–353

    Article  PubMed  Google Scholar 

  3. Chapple C (2013) Overactive bladder and underactive bladder: a symptom syndrome or urodynamic diagnosis? Neurourol Urodyn 32(4):305–307

    Article  PubMed  Google Scholar 

  4. Valente S et al (2014) Epidemiology and demographics of the underactive bladder:a cross-sectional survey. Int Urol Nephrol 46(Suppl 1):S7–S10

    Article  PubMed  Google Scholar 

  5. Taylor JA 3rd, Kuchel GA (2006) Detrusor underactivity: clinical features and pathogenesis of an underdiagnosed geriatric condition. J Am Geriatr Soc 54(12):1920–1932

    Article  PubMed  Google Scholar 

  6. Tyagi P et al (2014) Pathophysiology and animal modeling of underactive bladder. Int Urol Nephrol 46(Suppl. 1):S11–S21

    Article  PubMed  PubMed Central  Google Scholar 

  7. Smith PP (2010) Aging and the underactive detrusor: a failure of activity or activation? Neurourol Urodyn 29(3):408–412

    PubMed  Google Scholar 

  8. Osman NI et al (2014) Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol 65(2):389–398

    Article  PubMed  Google Scholar 

  9. Andersson KE (2014) Bladder underactivity. Eur Urol 65(2):399–401

    Article  PubMed  Google Scholar 

  10. van Koeveringe GA et al (2011) Detrusor underactivity: a plea for new approaches to a common bladder dysfunction. Neurourol Urodyn 30(5):723–728

    Article  PubMed  Google Scholar 

  11. Purohit RS et al (2008) The pathophysiology of large capacity bladder. J Urol 179(3):1006–1011

    Article  PubMed  Google Scholar 

  12. Eqqilmez T, Resit Goren M (2014) Catheterized uroflowmetry as a noninvasive test for detrusor acontractility. Urol Int 92(3):316–322

    Article  Google Scholar 

  13. Stav K et al (2013) Comparison of lower urinary tract symptoms between women with detrusor overactivity and impaired contractility, and detrusor overactivity and preserved contractility. J Urol 189(6):2175–2178

    Article  PubMed  Google Scholar 

  14. Griffiths DJ et al (2002) Urge incontinence and impaired detrusor contractility in the elderly. Neurourol Urodyn 21(2):126–131

    Article  PubMed  Google Scholar 

  15. Yamamoto T et al (2006) Neurological diseases that cause detrusor hyperactivity with Impaired contractile function. Neurourol Urodyn 25(4):356–360

    Article  PubMed  Google Scholar 

  16. Liu S, Chan L, Tse V (2014) Clinical outcome in male patients with detrusor overactivity with impaired contractility. Int Neurourol J 18(3):133–137

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chancellor MB, Kaufman J (2008) Case for pharmacotherapy development for underactive bladder. Urology 72(5):966–967

    Article  PubMed  Google Scholar 

  18. Underactive bladder foundation 2014. www.underactivebladder.org

  19. Cucchi A et al (2007) Urodynamic findings suggesting two-stage development of idiopathic detrusor underactivity in adult men. Urology 70(1):75–79

    Article  PubMed  Google Scholar 

  20. Smith PP, Chalmers DJ, Feinn RS (2015) Does defective volume sensation contribute to detrusor underactivity? Neurourol Urodyn 34(8):752–756

    Article  PubMed  Google Scholar 

  21. Chancellor MB, Diokno A (2014) CURE-UAB: shedding light on the underactive bladder syndrome. Int Urol Nephrol 46(Suppl 1):S1

    Article  PubMed  Google Scholar 

  22. Suskind AM, Smith PP (2009) A new look at detrusor underactivity: impaired contractility versus afferent dysfunction. Curr Urol Rep 10(5):347–351

    Article  PubMed  Google Scholar 

  23. Jeong SJ et al (2012) Prevalence and clinical features of detrusor underactivity among elderly with lower urinary tract symptoms: a comparison between men and women. Korean J Urol 53(5):342–348

    Article  PubMed  PubMed Central  Google Scholar 

  24. Abarbanel J, Marcus EL (2007) Impaired detrusor contractility in community dwelling elderly presenting with lower urinary tract symptoms. Urology 69(3):436–440

    Article  PubMed  Google Scholar 

  25. Diokno AC et al (1986) Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly. J Urol 136(5):1022–1025

    CAS  PubMed  Google Scholar 

  26. Belenky A et al (2003) Detrusor resistive index evaluated by Doppler ultrasonography as a potential indicator of bladder outlet obstruction. Urology 62(4):647–650

    Article  CAS  PubMed  Google Scholar 

  27. Thomas AW et al (2005) The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated detrusor underactivity. BJU Int 96(9):1295–1300

    Article  PubMed  Google Scholar 

  28. Lee JG, Shim KS, Koh SK (1999) Incidence of detrusor underactivity in men with prostatism older than 50 years. Korean J Urol 40(3):347–352

    Google Scholar 

  29. Smith PP, Hurtado EA, Appell RA (2009) Post hoc interpretation of urodynamic evaluation is qualitatively different than interpretation at the time of urodynamic study. Neurourol Urodyn 28(8):998–1002

    Article  PubMed  Google Scholar 

  30. Cucchi A, Quaglini S, Rovereto B (2008) Development of idiopathic detrusor underactivity in women: from isolated decrease in contraction velocity to obvious impairment of voiding function. Urology 71(5):844–848

    Article  PubMed  Google Scholar 

  31. Kuo HC (2007) Recovery of detrusor function after urethral botulinum A toxin injection in patients with idiopathic low detrusor contractility and voiding dysfunction. Urology 69(1):57–61

    Article  PubMed  Google Scholar 

  32. Andersson KE, Arner A (2004) Urinary bladder contraction and relaxation:physiology and pathophysiology. Physiol Rev 84(3):935–986

    Article  CAS  PubMed  Google Scholar 

  33. Oshiro T, Miyazato M, Saito S (2014) Relationship between connexin43-derived gap junction proteins in the bladder and age-related detrusor underactivity in rats. Life Sci 116(1):37–42

    Article  CAS  PubMed  Google Scholar 

  34. Griffiths D et al (2007) Cerebral control of the bladder in normal and urge-incontinent women. Neuroimage 37(1):1–7

    Article  PubMed  PubMed Central  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  36. Kalichman L et al (2009) Spinal stenosis prevalence and association with symptoms: the Framingham study. Spine J 9(7):545–550

    Article  PubMed  PubMed Central  Google Scholar 

  37. Meng NH et al (2010) Incomplete bladder emptying in patients with stroke: Is detrusor external sphincter dyssynergia a potential cause? Arch Phys Med Rehabil 91(7):1105–1109

    Article  PubMed  Google Scholar 

  38. Campos-Sousa RN et al (2003) Urinary symptoms in Parkinson’s disease: prevalence and associated factors. Arq Neuropsiquiatr 61(2B):359–363

    Article  PubMed  Google Scholar 

  39. Mesrobian HG (2014) Complete primary repair of bladder exstrophy is associated with detrusor underactivity type of neurogenic bladder. Urology 83(5):1139–1144

    Article  PubMed  Google Scholar 

  40. Giannantoni A et al (2004) Assessment of bladder and urethral sphincter function before and after radical retropubic prostatectomy. J Urol 171(4):1563–1566

    Article  PubMed  Google Scholar 

  41. Kielb SJ, Clemens JQ (2005) Comprehensive urodynamics evaluation of 146 men with incontinence after radical prostatectomy. Urology 66(2):392–396

    Article  PubMed  Google Scholar 

  42. Kitta T et al (2015) Postoperative detrusor contractility temporarily decreases in patients undergoing pelvic organ prolapse surgery. Int J Urol 22(2):201–205

    Article  PubMed  Google Scholar 

  43. Araki I et al (2009) Incontinence and detrusor dysfunction associated with pelvic organ prolapse: clinical value of preoperative urodynamic evaluation. Int Urogynecol J Pelvic Floor Dysfunct 20(11):1301–1306

    Article  PubMed  Google Scholar 

  44. Hakvoort RA et al (2009) Predicting short-term urinary retention after vaginal prolapse surgery. Neurourol Urodyn 28(3):225–228

    Article  PubMed  Google Scholar 

  45. Ouslander JG (2004) Management of overactive bladder. N Engl J Med 350(8):786–799

    Article  CAS  PubMed  Google Scholar 

  46. Bozikas V, Petrikis P, Karavatos A (2001) Urinary retention caused after fluoxetine-risperidone combination. J Psychopharmacol 15(2):142–143

    Article  CAS  PubMed  Google Scholar 

  47. Delgado JH et al (2004) Acute, transient urinary retention from combined ecstasy and methamphetamine use. J Emerg Med 26(2):173–175

    Article  PubMed  Google Scholar 

  48. Changolkar AK et al (2005) Diabetes induced decrease in detrusor smooth muscle force is associated with oxidative stress and overactivity of aldose reductase. J Urol 173(1):309–313

    Article  CAS  PubMed  Google Scholar 

  49. Chu FM, Dmochowski R (2006) Pathophysiology of overactive bladder. Am J Med 119(3 Suppl. 1):S3–S8

    Article  PubMed  Google Scholar 

  50. Sekido N et al (2012) A novel animal model of underactive bladder: analysis of lower urinary tract function in a rat lumbar canal stenosis model. Neurourol Urodyn 31(7):1190–1196

    Article  PubMed  Google Scholar 

  51. Jiang HH et al (2013) Bladder dysfunction changes from underactive to overactive after experimental traumatic brain injury. Exp Neurol 240:57–63

    Article  PubMed  Google Scholar 

  52. Saito M, Miyagawa I (2001) Bladder dysfunction after acute urinary retention in rats. J Urol 165(5):1745–1747

    Article  CAS  PubMed  Google Scholar 

  53. Kim DK et al (2009) Cystometric changes in pressure-guided acute distension rat model of the underactive bladder. Tzu Chi Med J 21(2):136–139

  54. Somogyi GT et al (2002) Effect of cryoinjury on the contractile parameters of bladder strips: a model of impaired detrusor contractility. Brain Res Bull 59(1):23–28

    Article  CAS  PubMed  Google Scholar 

  55. Nomiya M et al (2014) Progressive vascular damage may lead to bladder underactivity in rats. J Urol 191(5):1462–1469

    Article  PubMed  Google Scholar 

  56. Munoz A et al (2011) Overactive and underactive bladder dysfunction is reflected by alterations in urothelial ATP and NO release. Neurochem Int 58(3):295–300

    Article  CAS  PubMed  Google Scholar 

  57. Young JS et al (2013) The passive and active contractile properties of the neurogenic, underactive bladder. BJU Int 111(2):355–361

    Article  CAS  PubMed  Google Scholar 

  58. Nirmal J et al (2014) Functional and molecular characterization of hyposensitive underactive bladder tissue and urine in streptozotocin-induced diabetic rat. PLoS ONE 9(7):e102644

    Article  PubMed  PubMed Central  Google Scholar 

  59. Lai HH et al (2007) Using caveolin-1 knockout mouse to study impaired detrusor contractility and disrupted muscarinic activity in the aging bladder. Urology 69(2):407–411

    Article  PubMed  Google Scholar 

  60. van Koeveringe GA et al (2014) Detrusor underactivity: pathophysiological considerations, models and proposals for future research. ICI-RS 2013. Neurourol Urodyn 33(5):591–596

    Article  PubMed  PubMed Central  Google Scholar 

  61. Ukimura O et al (2003) Ultrasonic measurement of bladder weight as a novel urodynamic modality. Adv Exp Med Biol 539(Pt A):311–315

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

    Article  PubMed  Google Scholar 

  63. Cucchi A, Quaglini S, Rovereto B (2010) Different evolution of voiding function in underactive bladders with and without detrusor overactivity. J Urol 183(1):229–233

    Article  PubMed  Google Scholar 

  64. Casanova N, McGuire E, Fenner DE (2006) Botulinum toxin: a potential alternative to current treatment of neurogenic and idiopathic urinary incontinence due to detrusor overactivity. Int J Gynaecol Obstet 95(3):305–311

    Article  CAS  PubMed  Google Scholar 

  65. Bromage SJ et al (2010) Urodynamics in the octogenarian female: Is it worthwhile? Int Urogynecol J 21(9):1117–1121

    Article  PubMed  Google Scholar 

  66. Schaefer W (1990) Basic principles and clinical application of advanced analysis of bladder voiding function. Urol Clin N Am 17(3):553–566

    Google Scholar 

  67. Liao L, Schaefer W (2009) Within-session reproducibility and variability of urethral resistance and detrusor contractility in pressure-flow studies in men with lower urinary tract symptoms. Curr Urol 3(1):19–28

  68. Griffiths DJ (1991) Assessment of detrusor contraction strength or contractility. Neurourol Urodyn 10(1):1–18

    Article  Google Scholar 

  69. Abrams P (1999) Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int 84(1):14–15

    Article  CAS  PubMed  Google Scholar 

  70. Sullivan MP, Yalla SV (1996) Detrusor contractility and compliance characteristics in adult male patients with obstructive and nonobstructive voiding dysfunction. J Urol 155(6):1995–2000

    Article  CAS  PubMed  Google Scholar 

  71. Schäfer W (1995) Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple. World J Urol 13(1):47–58

    Article  PubMed  Google Scholar 

  72. Cucchi A, Quaglini S, Rovereto B (2009) Proposal for a urodynamic redefinition of detrusor underactivity. J Urol 181(1):225–229

    Article  PubMed  Google Scholar 

  73. Andersson KE (2010) Detrusor underactivity/underactive bladder: new research initiatives needed. J Urol 184(5):1829–1830

    Article  PubMed  Google Scholar 

  74. Jhang JF, Jiang YH, Kuo HC (2014) Transurethral Incision of the bladder neck improves voiding efficiency in female patients with detrusor underactivity. Int Urogynecol J 25(5):671–676

    Article  PubMed  Google Scholar 

  75. Barendrecht MM et al (2007) Is the use of parasympathomimetics for treating an underactive urinary bladder evidence-based? BJU Int 99(4):749–752

    Article  CAS  PubMed  Google Scholar 

  76. Barrett DM (1981) The effect of oral bethanechol chloride on voiding in female patients with excessive residual urine: a randomized double-blind study. J Urol 126(5):640–642

    CAS  PubMed  Google Scholar 

  77. Bougas DA et al (2004) Clinical efficacy of distigmine bromide in the treatment of patients with underactive detrusor. Int Urol Nephrol 36(4):507–512

    Article  PubMed  Google Scholar 

  78. Dasgupta R (2004) Prostaglandin E2 and bethanechol in combination for treating detrusor underactivity. BJU Int 94(1):191–192

    Article  PubMed  Google Scholar 

  79. Krishnamoorthy S, Kekre NS (2009) Detrusor underactivity: To tone or not to tone the bladder? Indian J Urol 25(3):407–408

    Article  PubMed  PubMed Central  Google Scholar 

  80. Rahnama’i MS et al (2012) The role of prostanoids in urinary bladder physiology. Nat Rev Urol 9(5):283–290

    Article  PubMed  Google Scholar 

  81. Kim JC et al (2005) Changes of urinary nerve growth factor and prostaglandins in male patients with overactive bladder symptom. Int Urol 12(10):875–880

    Article  CAS  Google Scholar 

  82. Sakakibara R et al (2000) Are alpha-blockers involved in lower urinary tract dysfunction in multiple system atrophy? A comparison of prazosin and moxisylyte. J Auton Nerv Syst 79(2–3):191–195

    Article  CAS  PubMed  Google Scholar 

  83. Chang SJ, Chiang IN, Yu HJ (2008) The effectiveness of tamsulosin in treating women with voiding difficulty. Int J Urol 15(11):981–985

    Article  CAS  PubMed  Google Scholar 

  84. Yamanishi T et al (2004) 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 11(2):88–96

    Article  CAS  PubMed  Google Scholar 

  85. Yoshii K et al (2011) Mechanism for distribution of acotiamide, a novel gastroprokinetic agent for treatment of functional dyspepsia, in rat stomach. J Pharm Sci 100(11):4965–4973

    Article  CAS  PubMed  Google Scholar 

  86. Sugimoto K et al (2015) A pilot study of acotiamide hydrochloride hydrate in patients with detrusor underactivity. Res Rep Urol 7:81–83

    CAS  PubMed  PubMed Central  Google Scholar 

  87. Phelan MW et al (2001) Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. J Urol 165(4):1107–1110

    Article  CAS  PubMed  Google Scholar 

  88. Mokhless I et al (2006) Botulinum A toxin urethral sphincter injection in children with nonneurogenic neurogenic bladder. J Urol 176(4 Pt 2):1767–1770

    Article  CAS  PubMed  Google Scholar 

  89. Liao YM, Kuo HC (2007) Causes of failed urethral botulinum toxin A treatment for emptying failure. Urology 70(4):763–766

    Article  PubMed  Google Scholar 

  90. Thorner DA et al (2014) Outcomes of reduction cystoplasty in men with impaired detrusor contractility. Urology 83(4):882–886

    Article  PubMed  Google Scholar 

  91. Gakis G et al (2011) Functional detrusor myoplasty for bladder acontractility: long-term results. J Urol 185(2):593–599

    Article  PubMed  Google Scholar 

  92. Moreno-Palacios J et al (2012) Outcomes and complications of sphincterotomy with bladder neck incision in neurologically healthy male patients with voiding dysfunction. Arch Esp Urol 65(2):244–250

    PubMed  Google Scholar 

  93. Mhiri MN, Bahloul A, Chabchoub K (2007) Mitrofanoff appendicovesicostomy in children: indication and results. Prog Urol 17(2):245–249

    Article  PubMed  Google Scholar 

  94. Kari J et al (2013) Is Mitrofanoff a more socially accepted clean intermittent catheterization (CIC) route for children and their families? Eur J Pediatr Surg 23(5):405–410

    PubMed  Google Scholar 

  95. Lombardi G et al (2014) Sacral neuromodulation for neurogenic non-obstructive urinary retention in incomplete spinal cord patients: a ten-year follow-up single-centre experience. Spinal Cord 52(3):241–245

    Article  CAS  PubMed  Google Scholar 

  96. Swinn MJ et al (2000) Sacral neuromodulation for women with Fowler’s syndrome. Eur Urol 38(4):439–443

    Article  CAS  PubMed  Google Scholar 

  97. Kavia R et al (2010) A functional magnetic resonance imaging study of the effect of sacral neuromodulation on brain responses in women with Fowler’s syndrome. BJU Int 105(3):366–372

    Article  PubMed  Google Scholar 

  98. Stöhrer M et al (2009) EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol 56(1):81–88

    Article  PubMed  Google Scholar 

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Funding

This study was funded by Chinese national natural science foundation (Grant Number 81270847).

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Authors and Affiliations

  1. Department of Urology, China Rehabilitation Research Center, No 10. Jiaomen Beilu, Fengtai District, Beijing, 100068, China

    Xing Li & Limin Liao

  2. Department of Urology, Capital Medical University, Beijing, China

    Xing Li & Limin Liao

  3. Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China

    Xing Li & Limin Liao

  4. Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China

    Xing Li & Limin Liao

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  1. Xing Li
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Correspondence to Limin Liao.

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Co-first authors: Xing Li and Limin Liao.

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Li, X., Liao, L. Updates of underactive bladder: a review of the recent literature. Int Urol Nephrol 48, 919–930 (2016). https://doi.org/10.1007/s11255-016-1251-x

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