The symptoms of detrusor overactivity with impaired contractility (DOIC) are not a little encountered in clinical practice, however, its pathogenesis and clinical characteristics have not yet been clearly identified. Using large-scale, urodynamic database, we aimed to identify the prevalence and patient characteristics of DOIC in comparison with that of detrusor overactivity (DO) and detrusor underactivity (DU) in the community-dwelling elderly women with nonneurogenic lower urinary tract symptoms (LUTS).

Based on a 11-year urodynamic database of the single institute, female elderly patients aged 65 or older who received a urodynamic evaluation for nonneurogenic LUTS were selected. Among these, data of 688 women were analyzed except for those who had impaired general health or could not perform daily tasks by themselves within 3 months prior to the examination, who had history of surgery or anatomical abnormality (urethral stricture, prolapse grade ≥3…) on the lower urinary tract, who were regularly using a catheter for urine drainage, or who could not void during a pressure-flow study (PFS). DOIC was defined when DO is observed in a filling cystometry and detrusor pressure at maximal flow (PdetQmax) is less than 30cmH2O and maximal flow rate (Qmax) is less than 10mL/s in a PFS. The prevalence rate of DOIC was identified and the characteristics of women with DOIC were compared with those with DO or DU only.

DOIC was identified at 5.5%, DO at 32.6% and DU at 13.1% in the total population. When age was divided by five years in order of age, prevalence rate of DOIC was 2.7%, 7.8%, 5.7%, and 13.9%, showing a significant increase with age (p = 0.005). The prevalence rate has also tended to increase in recent years, depending on the year in which the studies were conducted. Compared to women with DO only, DOIC group had significantly smaller Qmax and voiding efficiency in free uroflowmetry (UFM), smaller volumes at first sensation at bladder filling, first desire to void, and strong desire to void, and smaller maximum cystometry capacity (MCC). However, there were no significant differences in patient age, amount of post-void residual (PVR), and detrusor compliance between the two groups. When compared to women with DU only, volumes at first sensation at bladder filling, first desire to void, and strong desire to void, and MCC were significantly smaller in those with DOIC. PdetQmax was significantly higher in this group than in DU only group. While, there were no statistical differences in patient age, Qmax, amount of PVR, and voiding efficiency in free UFM, and detrusor compliance between women with DOIC and DU only.

So far, the pathogenesis and patient characteristics of DOIC have not yet been clearly identified. We tried to determine the prevalence and patient characteristics of DOIC in comparison with that of DO and DU in the community-dwelling elderly women with nonneurogenic LUTS using large-scale, urodynamic database. While some urodynamic features were different between groups, the specific urodynamic features of women with DOIC were more similar to those of individuals with only DU than those with only DO.

The prevalence of DOIC in the community-dwelling elderly women increases with age, and urodynamic features of the elderly women with DOIC may be more similar to those of individuals with DU only than those with DO only. The amount of PVR does not reflect the characteristics of DOIC in this population.