SUFU 2021: Underactive Bladder or Detrusor Underactivity? Evaluation and Treatment Update

( Underactive bladder (UAB) has been under-discussed and under-researched for years, despite the fact it is common, severe, and lacks effective treatment.  It is one of the greatest areas of unmet need and yet has the greatest opportunity for advancement in functional urology. Dr. Christopher Chapple recommended the 2020 review by Mike Chancellor. The etiology of UAB is complex, many times there is no diagnosis or cause and it is termed “idiopathic” detrusor underactivity. Detrusor underactivity (DUA or DU) is diagnosed by urodynamics based on pressure-flow characterized by low-pressure, and/or poorly sustained detrusor contraction in combination with low urinary flow.

UAB is the clinical syndrome that accompanies detrusor underactivity. DUA/UAB occurs when the bladder is unable to produce an effective voiding contraction or if there is incomplete bladder emptying, leading in time to chronic retention. There is no single ideal animal model for DUA or UAB. The ICS terminology committee proposed definition for UAB is “a slow urinary stream, hesitancy and straining to void with to without a feeling of incomplete bladder emptying and dribbling, often with storage symptoms” as there can be a large residual. May be factors related to age gender, presence of neurologic conditions.

As to prevalence, DUA affects 9-28% of men < 50 yrs and in 48% of those undergoing UDS.  In women undergoing UDS, DUA affects 12-45%. It is more prevalent in institutionalized elderly. As to treatment, conservative approaches are recommended (schedule and double voiding, PT with biofeedback, and catheterization. Drug therapy has not been very effective. Sacral neuromodulation has been suggested. Long-term monitoring may be an option.

Presented by: Christopher Chapple, MD, Sheffield Teaching Hospitals, NHS Foundation Trust UK

Written by: Diane K. Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practioner and Co-Director, Penn Center for Continence and Pelvic Health Adjunct Professor of Urology in Surgery during the 2021 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting