Pathophysiology and Associations of Underactive Bladder
Underactive bladder (UAB; symptom diagnosis) and detrusor underactivity (DUA; urodynamic diagnosis) are common, aging-related, multifactorial conditions. Aging per se may cause changes in bladder structure and function, but other concomitant disorders suc
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Pathophysiology and Associations of Underactive Bladder K.E. Andersson
Key Points
• Underactive bladder (UAB) and detrusor underactivity (DUA) are common, aging-related, multifactorial conditions • Aging may be an etiological factor, but concomitant disorders may aggravate aging-induced reduction in bladder structure and function • Bladder outflow obstruction, diabetes mellitus, neurogenic disorders, and ischemic bladder dysfunction, are often associated with UAB/DUA • Impaired detrusor contractility has been regarded as a major etiologic factor of UAB/DUA, but disturbances of bladder sensory afferents and the central nervous system control of micturition and changes in efferent neurotransmission may be as important • Chronic bladder ischemia and resultant oxidative stress may cause detrusor overactivity progressing to DUA and inability to empty the bladder.
Introduction Impaired bladder emptying is a common clinical condition described in different ways. Detrusor underactivity (DU or DUA) has been defined by the International Continence Society [1] and is a urodynamic diagnosis requiring invasive pressure flow studies (PFS). It is defined as a detrusor contraction of reduced strength and/or
K.E. Andersson, MD, PhD Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA Clinical Medicine, Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200 Aarhus N, Denmark e-mail: [email protected] © Springer International Publishing Switzerland 2017 C.R. Chapple et al. (eds.), Underactive Bladder, DOI 10.1007/978-3-319-43087-4_1
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duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span. It is characterized by a lowpressure, poorly sustained, or wave-like detrusor contraction with an associated poor flow rate [2, 3]. In order to identify the clinical features associated with DUA, Gammie et al. [3] investigated 1788 patient records (men: 507; women: 1281) classified as DUA, bladder outflow obstruction (BOO), or normal PFS. They found that both men and women with DUA reported a statistically significantly higher occurrence of decreased and/or interrupted urinary stream, hesitancy, feeling of incomplete bladder emptying, palpable bladder, feeling of incomplete bowel emptying, absent and/or decreased sensation, and always straining to void, compared with men and women with normal PFS. However, Gammie et al. [3] also found interesting differences between the groups and concluded that there are signs and symptoms that can distinguish men and women with DUA from patients with normal PFS, and further distinguish between DUA and BOO. The term underactive bladder (UAB) has been used by several investigators [4, 5] referring to a clinical condition in a broader sense mirroring the overactive bladder (OAB) syndrome. Based on their findings, Gammie et al. [3] concluded that the clinical presentation of DUA patients is consistent w
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