[Pathophysiology of detrusor underactivity in the elderly]

The aim of this study was to review the evidence regarding the pathophysiology of detrusor underactivity in the elderly.

A literature review was conducted in July 2016 using the Medline/Pubmed database limiting the search to works in English or French.

The prevalence of detrusor underactivity has been reported to range from 8% to 48% depending on the definition used and the age of the population studied. Current data suggest that aging may itself be a causative factor of detrusor underactivity through myogenic dysfunctions (ultrastructural degeneration of the detrusor muscle) and neurogenic dysfunctions (by degeneration of efferent but mostly afferent innervation mechanisms). Beyond these inherently age-related mechanisms, many comorbidities whose prevalence increase with age (diabetes, bladder outlet obstruction, estrogen deficiency, atherosclerosis, etc.) may be implicated in the development of detrusor underactivity in the elderly. The role played by detrusor overactivity in the appearance of detrusor underactivity must be considered separately as both seem to be the expression of the same condition of the lower urinary tract responding to different stages and secondary to numerous etiopathogenic factors which modulate its progression and clinical expressions.

Pathophysiology of detrusor underactivity remains poorly understood but seems to imply myogenic and neurogenic factors which are favored, besides the aging per se, by various and numerous comorbidities which prevalence increase with age (diabetes, bladder outlet obstruction…).

Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2017 May 22 [Epub ahead of print]

J Kerdraon, B Peyronnet, X Gamé, B Fatton, R Haddad, C Hentzen, C Jeandel, P Mares, M Mezzadri, A-C Petit, G Robain, J-M Vetel, G Amarenco, Groupe de recherche appliquée à la pelvi-périnéologie de la personne âgée (GRAPPPA)

Centre mutualiste de rééducation et réadaptation Kerpape, BP 78, 56275 Ploemeur cedex, France. Electronic address: ., Service d'urologie, CHU de Rennes, 35000 Rennes, France., Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, 31000 Toulouse, France., Service d'urologie, CHRU Carémeau, 30029 Nîmes cedex 9, France., Service de médecine physique et rééducation, hôpital Rotschild, 75012 Paris, France., Sorbonne universités, UPMC université Paris 06, AP-HP, GRC 01, groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France., Service de gériatrie, CHU de Montpellier, 34000 Montpellier, France., Service de gynécologie, hôpital Lariboisière, 75010 Paris, France., Centre de santé, 8, rue Neibecker, 93440 Dugny, France., Service de gériatrie, centre hospitalier du Mans, 72074 Le Mans, France.