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Making sense of detrusor underactivity and the underactive bladder

Thursday 07 Jul 2016 {{NI.ViewCount}} Views {{NI.ViewCount}} Views

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This is the second in a series of ICS publication in collaboration with Urology News. This first, by Paula Igualada-Martinez reviewed the history of pelvic floor physical therapy. The current article by Nadir Osman reviews the challenges of lower urinary tract symptoms related to underactive bladder. Below is a summary of the article. To view the entire publication click here.

Countless epidemiological studies have established the frequent occurrence of lower urinary tract symptoms (LUTS) and the significant burden they incur. For the past three decades, there has been overwhelming focus on detrusor overactivity (DO) and bladder outlet obstruction (BOO) as the underlying pathophysiological abnormalities of LUTS. Consequently there has been a boon in basic and clinical science research, which has given rise to numerous innovations in pharmacological and surgical therapy. By contrast, the problem of detrusor underactivity (DU) has been less studied. It is salutary to note that the last major advance in management was the introduction of clean intermittent self-catheterisation by the American urologist Jack Lapides some 40 years ago. Recently, there has been resurgence in interest in DU with efforts to better define the problem, understand its epidemiology and develop better diagnostic approaches with novel treatments.

In the article the following sections are discussed:

  • Terminology
  • Signs and symptoms
  • Epidemiology
  • Pathogenesis
  • Diagnosis
  • Management

DU is a poorly understood and under-researched bladder dysfunction. The symptom based correlate of DU is underactive bladder (UAB) however this term remains unclearly defined. There is a need for further epidemiological studies to better understand the population prevalence of DU/UAB and identify at risk groups. The aetiology of DU is multifactorial while the pathophysiological mechanisms are unknown in many cases. A better understanding of the mechanisms involved in the generation of normal detrusor contraction is needed. This will hopefully facilitate the development of effective treatments which are at present drastically lacking.

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Article by Nadir Osman on behalf of the ICS Education Committee

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