PARIS, FRANCE (UroToday.com) - The prevalence and clinical implications of detrusor underactivity (DU) in the community-dwelling elderly population remain largely unknown, and subsequently, proper diagnosis and management of DU is challenging for physicians caring for the elderly with lower urinary tract symptoms (LUTS).
We tried to identify the prevalence and clinical features of DU in the community-dwelling elderly men and women presenting with LUTS, so as to contribute to the accumulation of basic knowledge regarding this condition.
They reviewed the computerized medical records of 1,179 patients aged over 65 who had undergone an urodynamic study for LUTS between May 2003 and June 2010 without known or suspected neurological or anatomical conditions. All the patients were able to perform daily tasks by themselves and did not use a catheter for urine drainage on regular basis. DU was defined as a bladder contractility index 2O for women.
The mean age was 72.3 and 72.0 years for men and women, respectively. Of all of the patients, 40.2% of 632 men and 13.3% of 547 women were classified as having DU (p <0.001, between men and women). Types of clinical symptoms were not different between patients with and without DU. In men, while the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO and/or BOO. In women, prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70. DU was accompanied by DO and/or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity (p = 0.048) and exhibited a greater incidence of reduced compliance (16.4%, p <0.001) than women without DU. Pharmacotherapy for patients with DU was performed with α-adrenoreceptor antagonist in 78.0 and 20.5%, cholinergic agonist in 26.8 and 31.5%, and muscle relaxant in 7.5 and 8.2% of the men and women, respectively. Only 14.6 and 8.2% of the men and women with DU used a catheter for urine drainage as treatments.
DU was a common mechanism underlying LUTS in the community-dwelling elderly, especially in men. Clinical symptoms did not differentiate the presence of DU from other urodynamic-proven pathologies. One half of the men and three quarters of the women with DU also had other pathologies such as DO/BOO/USUI. DU seems to be related to reduced bladder compliance, which subsequently results in a lower cystometric capacity in elderly females.
Presented by Jeong SJ, Lee YJ, Lee JK, Lee BK, Choo YM, Oh JJ, Lee, SC, Jeong CW, Yoon CY, Hong SK, Byun SS, and Lee SE at the 27th Annual European Association of Urology (EAU) Congress - February 24 - 28, 2012 - Le Palais des Congrès de Paris, Paris, France
Seoul National University Bundang Hospital, Dept. of Urology, Seongnam, Korea, South