San Diego, CA USA (UroToday.com) Moderator Alan Wein began by discussing the importance of the topic of detrusor underactivity as a common and challenging clinical entity.
Chris Chapple discussed the State-of-the-Art: Pathophysiology of Detrusor Underactivity. He first put detrusor underactivity into the context of the terminology/clinical definition of the Underactive Bladder Syndrome (UAB).
He then discussed the urodynamic characteristics of the condition, discussing the differentiation of a bladder that does not contract during a study in a urodynamics lab, versus acontracile bladder that can't contract at all. He also described the clinical importance of differentiating between acontractile and underactive detrusor; which may have impact on therapies offered. He considered the types of measurements of bladder contractility, including the Watts Factor, which he highlighted as complex calculation with no accepted cutoffs, and the projected isovolumetric pressure, detrusor coefficient, and bladder contractility index. He mentioned that there is no consensus on the best way to measure bladder contractility.
He then discussed epidemiology of detrusor underactivity and the high prevalence of this condition, however this data comes from patients undergoing urodynamics, and not the not clinically defined syndrome. He also discussed the various etiologies of detrusor underactivity including idiopathic, myogenic, neuropathic and other factors. He mentioned that the individual patient may have a sensory problems, motor problems, or a combination of both.
In describing the future directions of research on detrusor underactivity, he noted many challenge, including that there is no ideal patient to study, since the syndrome had many causes and many different symptoms. He also discussed that there is no available animal model to study, and that variations in physiology may make an animal model difficult to create.
Alan Wein concluded the session on detrusor underactivity by reiterating the many shortcomings on or current knowledge of this common condition.
Presented By: Alan Wein, Chris Chapple
Written By: Lindsey Cassini Cox M.D. Clinical Assistant Professor, Female Pelvic Medicine & Reconstructive Surgery, MUSC Health, Medical University of South Carolina, at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA