Underactive bladder and detrusor underactivity represent different facets of volume hyposensitivity and not impaired contractility
Main Article Content
Keywords
underactive bladder, detrusor underactivity, urodynamicsadder, Urodynamics
Abstract
OBJECTIVES: Underactive bladder (UAB) and detrusor underactivity (DU) are receiving increasing clinical and research attention. Although lacking a formalized definition, UAB is described as a symptom complex, while DU is a standardized statement of urodynamic function. Both terms nominally suggest impaired detrusor contractility leading to disordered emptying. We sought to evaluate the relationship between UAB, DU and detrusor contractility.
METHODS:A chart review of 256 urodynamic records from clinical practice was conducted. Data about symptoms and urodynamic performance were extracted and analyzed, comparing measures of sensory and motor function among groups based on symptoms and urodynamic observations.
RESULTS: One hundred and ninety eight complete urodynamic studies met ad hoc defined criteria for inclusion. UAB is specific (0.90) for, but not sensitive (0.22) to, DU. Increased post-void residual volume is common to both UAB and DU, but neither is associated with impaired contractility as measured by Watts factor. Patients with UAB and DU demonstrate higher sensation volume thresholds than do those without these symptoms or observations.
CONCLUSIONS: The symptom complex of UAB is not a reliable predictor of the urodynamic observation of DU, and neither condition is associated with a diminished Watts factor. Our results suggest that UAB and DU are typically disorders of volume hyposensitivity rather than of impaired contractility, and may differ in their relationship to bladder perceptions. Thus, these terms should not be used interchangeably.
METHODS:A chart review of 256 urodynamic records from clinical practice was conducted. Data about symptoms and urodynamic performance were extracted and analyzed, comparing measures of sensory and motor function among groups based on symptoms and urodynamic observations.
RESULTS: One hundred and ninety eight complete urodynamic studies met ad hoc defined criteria for inclusion. UAB is specific (0.90) for, but not sensitive (0.22) to, DU. Increased post-void residual volume is common to both UAB and DU, but neither is associated with impaired contractility as measured by Watts factor. Patients with UAB and DU demonstrate higher sensation volume thresholds than do those without these symptoms or observations.
CONCLUSIONS: The symptom complex of UAB is not a reliable predictor of the urodynamic observation of DU, and neither condition is associated with a diminished Watts factor. Our results suggest that UAB and DU are typically disorders of volume hyposensitivity rather than of impaired contractility, and may differ in their relationship to bladder perceptions. Thus, these terms should not be used interchangeably.
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References
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15. Wyndaele JJ. THE NORMAL PATTERN OF PERCEPTION OF BLADDER FILLING DURING CYSTOMETRY STUDIED IN 38 YOUNG HEALTHY VOLUNTEERS. The Journal of Urology. 1998;160(2):479-81.
16. le Feber J, van Asselt E, van Mastrigt R. Afferent bladder nerve activity in the rat: a mechanism for starting and stopping voiding contractions. Urological Research. 2004;32(6):395-405.
17. Taylor JA, 3rd, Kuchel GA. Detrusor underactivity: Clinical features and pathogenesis of an underdiagnosed geriatric condition. J Am Geriatr Soc. 2006;54(12):1920-32. Epub 2007/01/03.
18. Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. Jama. 1987;257(22):3076-81.
19. Chancellor MB. The overactive bladder progression to underactive bladder hypothesis. Int Urol Nephrol. 2014;46 Suppl 1:23-7.
20. Broekhuis SR, Kluivers KB, Hendriks JCM, Massolt ET, Groen J, Vierhout ME. Reproducibility of same session repeated cystometry and pressure-flow studies in women with symptoms of urinary incontinence. Neurourology and Urodynamics. 2010;29(3):428-31.
21. Van Meel TD, Wyndaele JJ. Reproducibility of urodynamic filling sensation at weekly interval in healthy volunteers and in women with detrusor overactivity. Neurourol Urodyn. 2011. Epub 2011/05/04.
2. Mayo ME, Hinman F. Structure and function of the rabbit bladder altered by chronic obstruction or cystitis. Investigative urology. 1976;14(1):6-9.
3. Blaivas JG. Pathophysiology and differential diagnosis of benign prostatic hypertrophy. Urology. 1988;32(6 Suppl):5-11. Epub 1988/12/01.
4. Lai HH, Boone TB, Yang G, Smith CP, Kiss S, Thompson TC, et al. Loss of caveolin-1 expression is associated with disruption of muscarinic cholinergic activities in the urinary bladder. Neurochem Int. 2004;45(8):1185-93. Epub 2004/09/24. doi: 10.1016/j.neuint.2004.06.016
S0197-0186(04)00125-1 [pii].
5. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-78. Epub 2002/02/22. doi: 10.1002/nau.10052 [pii].
6. Elbadawi A, Yalla SV, Resnick NM. Structural basis of geriatric voiding dysfunction. II. Aging detrusor: normal versus impaired contractility. J Urol. 1993;150(5 Pt 2):1657-67.
7. Chancellor MB, Diokno A. CURE-UAB: shedding light on the underactive bladder syndrome. Int Urol Nephrol. 2014;46 Suppl 1:1.
8. Schäfer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A, et al. Good urodynamic practices: Uroflowmetry, filling cystometry, and pressure-flow studies. Neurourology and Urodynamics. 2002;21(3):261-74.
9. Underactive Bladder Foundation 2014 [January 2014].
10. Gormley EA, Lightner DJ, Burgio K, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline. American Urological Association (AUA) Guidelines [Internet]. 2012. Available from: http://www.auanet.org/content/media/OAB_guideline.pdf.
11. Chapple CR, Osman NI, Birder L, van Koeveringe GA, Oelke M, Nitti VW, et al. The Underactive Bladder: A New Clinical Concept? Eur Urol. 2015.
12. Chapple CR, Birder L, van Koeveringe G, Oelke M, Nitti VW, Drake M, et al. The Underactive Bladder: a new clinical concept? European Urology. 2014;in press.
13. Lecamwasam HS, Yalla SV, Cravalho EG, Sullivan MP. The maximum watts factor as a measure of detrusor contractility independent of outlet resistance. Neurourol Urodyn. 1998;17(6):621-35.
14. Heeringa R, de Wachter SG, van Kerrebroeck PE, van Koeveringe GA. Normal bladder sensations in healthy volunteers: A focus group investigation. Neurourol Urodyn. 2011. Epub 2011/05/25.
15. Wyndaele JJ. THE NORMAL PATTERN OF PERCEPTION OF BLADDER FILLING DURING CYSTOMETRY STUDIED IN 38 YOUNG HEALTHY VOLUNTEERS. The Journal of Urology. 1998;160(2):479-81.
16. le Feber J, van Asselt E, van Mastrigt R. Afferent bladder nerve activity in the rat: a mechanism for starting and stopping voiding contractions. Urological Research. 2004;32(6):395-405.
17. Taylor JA, 3rd, Kuchel GA. Detrusor underactivity: Clinical features and pathogenesis of an underdiagnosed geriatric condition. J Am Geriatr Soc. 2006;54(12):1920-32. Epub 2007/01/03.
18. Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients. Jama. 1987;257(22):3076-81.
19. Chancellor MB. The overactive bladder progression to underactive bladder hypothesis. Int Urol Nephrol. 2014;46 Suppl 1:23-7.
20. Broekhuis SR, Kluivers KB, Hendriks JCM, Massolt ET, Groen J, Vierhout ME. Reproducibility of same session repeated cystometry and pressure-flow studies in women with symptoms of urinary incontinence. Neurourology and Urodynamics. 2010;29(3):428-31.
21. Van Meel TD, Wyndaele JJ. Reproducibility of urodynamic filling sensation at weekly interval in healthy volunteers and in women with detrusor overactivity. Neurourol Urodyn. 2011. Epub 2011/05/04.
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Published
Jul 27, 2015
Article Details
How to Cite
Smith, P. P., Pregenzer, G., Galffy, A., & Kuchel, G. A. (2015). Underactive bladder and detrusor underactivity represent different facets of volume hyposensitivity and not impaired contractility. Bladder, 2(2), e17. https://doi.org/10.14440/bladder.2015.60
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Research Articles
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Author Biography
Phillip P. Smith, University of Connecticut Health Center Farmington CT
Associate Professor of Urology and Gynecology, Department of Surgery
Research Associate, Center on Aging
