Abstract
Detrusor hyperactivity with impaired contractile function (DHIC) is a complex voiding dysfunction that is often misdiagnosed as incontinence resulting from benign prostatic hyperplasia with outlet obstruction, underactive detrusor with chronic retention, and stress urinary incontinence due to sphincter incompetence, particularly in women. Urodynamic assessments have shown that these subjects exhibit low pressure and almost unrecognizable involuntary detrusor contractions associated with reflex urethral relaxation accompanied with inefficient bladder emptying. These patients therefore tend to develop high residual volumes with a tendency towards chronic urinary retention. DHIC is a major cause of urinary incontinence in institutionalized elderly women. Accurate diagnosis requires awareness of this condition, careful video-urodynamic evaluation, and elimination of other disorders such as outlet obstruction and neurogenic bladder that confound DHIC. The exact causes are unclear, although some studies indicate that this entity may be a coincidental association of two separate etiologies, with each one independently contributing to the two different components of DHIC. Alternately, impaired detrusor function could emerge as a long-term sequelae of detrusor overactivity. Recent ultrastructural studies of the bladder in those with DHIC show distinct morphological patterns characteristic of both detrusor overactivity and impaired contractility. Management of this condition requires knowing that the condition potentially causes incontinence in women and lower urinary tract symptoms in men. Failure to diagnose DHIC in symptomatic patients may lead to inappropriate therapies including morbidity-prone surgical misadventures.
Similar content being viewed by others
References and Recommended Reading
Wilson TS: Incontinence of urine in the aged. Lancet 1948, 251:374–378.
Brocklehurst JC, Dillane JB: Studies of the female bladder in old age: cystometrograms in 100 incontinent women. Gerontol Clin (Basel) 1966, 8:306–319.
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.
Griffiths DJ, McCracken PN, Harrison GM, et al.: Urge incontinence and impaired detrusor contractility. Neurourol Urodyn 2002, 21:126–131.
Taylor JA, Kuchel GA: Detrusor underactivity: clinical features and pathogenesis of an underdiagnosed geriatric condition. J Am Geriatr Soc 2006, 54:1920–1932.
Pfisterer M, Griffiths DJ, Schaefer W, et al.: The impact of age on lower urinary tract function: a study in women. J Am Geriatr Soc 2006, 54:405–412.
Elbadawi A, Yalla SV, Resnick NM: Structural basis for geriatric voiding dysfunction. III: Detrusor overactivity. J Urol 1993, 150:1668–1680.
Elbadawi A, Yalla SV, Resnick NM: Structural basis of geriatric voiding dysfunction. II: Aging detrusor: normal vs impaired contractility. J Urol 1993, 150:1657–1667.
Sui GP, Coppen SR, Dupont E, et al.: Impedance measurements and connexin expression in human detrusor muscle from stable and unstable bladders. BJU Int 2003, 92:297–305.
Christ GJ, Day NS, Day M, et al.: Increased connexin43-mediated intercellular communication in a rat model of bladder overactivity in vivo. Am J Physiol Regul Integr Comp Physiol 2003, 284:R1241–R1248.
Cristofaro V, Peters CA, Yalla SV, Sullivan MP: Smooth muscle caveolae differentially regulate specific agonist induced bladder contractions. Neurourol Urodyn 2007, 26:71–80.
Boone T, Thompson TC, Smith CP, Somogyi GT: Caveolin-1 knockout mice can be used as an animal model to study the effects of aging on detrusor hypocontraction and bladder overactivity. J Urol 2006, 175:52A.
Azadzoi KM, Tarcan T, Kozlowski R, et al.: Overactivity and structural changes in the chronically ischemic bladder. J Urol 1999, 162:1768–1778.
Resnick NM, Yalla SV, Laurino E: The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med 1987, 320:1–7.
Resnick NM, Brandeis G, Baumann MM, et al.: Misdiagnosis of urinary incontinence in nursing home women: prevalence and a proposed solution. Neurourol Urodyn 1996, 15:599–613; discussion 613–618.
Resnick NM, Yalla SV: Geriatric incontinence and voiding dysfunction. In Campbell-Walsh Urology, edn 9. Edited by Wein A, Kavoussi L, Novick A, et al.: Philadelphia: Saunders; 2007:2305–2321.
Ameda K, Sullivan MP, Bae RJ, Yalla SV: Urodynamic characterization of non obstructive voiding dysfunction in symptomatic elderly men. J Urol 1999, 162:142–146.
Sullivan MP, DuBeau CE, Resnick NM, et al.: Continuous occlusion test to determine detrusor contractile performance. J Urol 1995, 154:1834–1840.
Griffiths DJ: Assessment of detrusor contraction strength or contractility. Neurourol Urodyn 1991, 10:1–18.
Sullivan MP, Yalla SV: Detrusor contractility and compliance characteristics in patients with bladder outlet obstruction. J Urol 1996, 155:1995–2000.
Cucchi A: Some observations on a condition of relatively lower detrusor contractility in stable versus unstable unobstructed bladders. Neurourol Urodyn 1995, 14:317–324.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yalla, S.V., Sullivan, M.P. & Resnick, N.M. Update on detrusor hyperactivity with impaired contractility. Curr Bladder Dysfunct Rep 2, 191–196 (2007). https://doi.org/10.1007/s11884-007-0019-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11884-007-0019-7