Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women.:
Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women.
Korean J Urol. 2012 May;53(5):342-8
Authors: Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM, Oh JJ, Lee SC, Jeong CW, Yoon CY, Hong SK, Byun SS, Lee SE
Abstract
PURPOSE: To identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS).
MATERIALS AND METHODS: We reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) ≤12 ml/s combined with a detrusor pressure at Qmax ≤10 cmH(2)O for men and women, respectively.
RESULTS: Of the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU.
CONCLUSIONS: DU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.
PMID: 22670194 [PubMed – in process]
Last Updated: July 27, 2020 by uabadmin
Usefulness of total bladder capacity and post-void residual urine volume as a predictor of detrusor overactivity with impaired contractility in stroke patients.
Usefulness of total bladder capacity and post-void residual urine volume as a predictor of detrusor overactivity with impaired contractility in stroke patients.:
Usefulness of total bladder capacity and post-void residual urine volume as a predictor of detrusor overactivity with impaired contractility in stroke patients.
Exp Ther Med. 2012 Dec;4(6):1112-1116
Authors: Lee SH, Lee JG, Min GE, Lee HL, Lee CH, Yoo KH
Abstract
Detrusor overactivity (DO) with impaired contractility (DOIC) is a mixed pattern of involuntary contraction and increased post-void residual urine volume (PVR) which occurs in stroke patients. Urodynamic study results obtained from patients with detrusor abnormalities and stroke were analyzed to identify the associations between various urodynamic parameters and DOIC. Between August 2003 and November 2010, 127 patients were selected from 178 patients undergoing urodynamic study due to urinary symptoms. Stroke patients were divided into three groups: the DO, DOIC and detrusor underactivity (DU) groups. The significance of differences between the three groups was analyzed using the Kruskal-Wallis test and receiver operating characteristic (ROC) curves were used to calculate the accuracy of the urodynamic study result factors to distinguish between the three groups. The average total bladder capacity (TBC) was 219.15±98.30 ml in the DO, 330.25±115.75 ml in the DOIC and 486.00±111.48 ml in the DU (P<0.001) group. The average PVR was 22.64±20.85 ml in the DO, 146.87±95.09 ml in the DOIC and 425.33±136.70 ml in the DU (P<0.001) group. A ROC curve of DO and DOIC revealed that TBC and PVR were significantly different between the DOIC and DO groups. The area under the curve (AUC) of TBC was 0.812 (P<0.001) and that of PVR was 0.987 (P<0.001). A ROC curve of DOIC and DU revealed that TBC and PVR were significantly different between the DOIC and DU groups. The AUC of TBC was 0.813 (P<0.001) and that of PVR was 0.929 (P<0.001). In the urodynamic study of stroke patients with urinary symptoms, TBC and PVR may provide useful information for treating patients who cannot undergo urodynamic study.
PMID: 23226784 [PubMed – as supplied by publisher]
Last Updated: July 27, 2020 by uabadmin
Effects of intravesical electrical stimulation therapy on urodynamic patterns for children with spina bifida: A 10-year experience.
Effects of intravesical electrical stimulation therapy on urodynamic patterns for children with spina bifida: A 10-year experience.:
Effects of intravesical electrical stimulation therapy on urodynamic patterns for children with spina bifida: A 10-year experience.
J Pediatr Urol. 2012 Nov 21;
Authors: Choi EK, Hong CH, Kim MJ, Im YJ, Jung HJ, Han SW
Abstract
OBJECTIVE: Intravesical electrical stimulation (IVES) has been performed for various purposes in children with a neurogenic bladder. We evaluated the results of IVES on urodynamic study parameters in children with spina bifida. METHODS: We retrospectively analyzed the cases of 88 children who received IVES between August 1999 and May 2010 and whose comparative urodynamic data were available before and after treatment. According to the pre-IVES urodynamic study, children were divided into 3 groups: detrusor overactivity, detrusor underactivity and acontractile detrusor. We investigated the changes in detrusor function, bladder capacity and detrusor-sphincter dyssynergia. RESULTS: In the group showing detrusor overactivity, the bladder had a synergic pattern in 41.7%, and normal detrusor function was observed in 16.7% of them. Bladder capacity increased after IVES therapy, especially in those who started therapy before 18 months of age (p = 0.019). Detrusor-sphincter dyssynergia was resolved in 55.6%. In the acontractile detrusor group, detrusor contraction ability increased in 48%, but bladder capacity did not. CONCLUSIONS: Appropriate candidates for this treatment need to be carefully selected.
PMID: 23177928 [PubMed – as supplied by publisher]
Last Updated: July 27, 2020 by uabadmin 1 Comment
Bladder dysfunction changes from underactive to overactive after experimental traumatic brain injury.
Bladder dysfunction changes from underactive to overactive after experimental traumatic brain injury.:
Bladder dysfunction changes from underactive to overactive after experimental traumatic brain injury.
Exp Neurol. 2012 Nov 21;
Authors: Jiang HH, Kokiko-Cochran ON, Li K, Balog B, Lin CY, Damaser MS, Lin V, Cheng JY, Lee YS
Abstract
Although bladder dysfunction is common after traumatic brain injury (TBI), few studies have investigated resultant bladder changes and the detailed relationship between TBI and bladder dysfunction. The goal of this study was to characterize the effects of TBI on bladder function in an animal model. Fluid-percussion injury was used to create an animal model with moderate TBI. Female Sprague-Dawley rats underwent TBI, sham TBI or were not manipulated (naïve). All rats underwent filling cystometry while bladder pressure and external urethral sphincter electromyograms were simultaneously recorded 1day, 1week, 2weeks, and 1month after injury. One day after injury, 70% of the animals in the TBI group and 29% of the animals in the sham TBI group showed no bursting activity during urination. Compared to naïve rats, bladder function was mainly altered 1day and 1week after sham TBI, suggesting the craniotomy procedure affected bladder function mostly in a temporary manner. Compared to either naïve or sham TBI, bladder weight was significantly increased 1month after TBI and collagen in the bladder wall was increased. Bladder function in the TBI group went from atonic 1day post-TBI to overactive 1month post-TBI, suggesting that TBI significantly affected bladder function.
PMID: 23178579 [PubMed – as supplied by publisher]
Last Updated: July 27, 2020 by uabadmin
Lower urinary tract symptoms of neurological origin in urological practice.
Lower urinary tract symptoms of neurological origin in urological practice.:
Lower urinary tract symptoms of neurological origin in urological practice.
Clin Auton Res. 2012 Oct 26;
Authors: Magari T, Fukabori Y, Ogura H, Suzuki K
Abstract
PURPOSE: The present study aimed to reveal the neurological origin of lower urinary tract symptoms (LUTS) in routine urological examination. METHODS: We retrospectively analyzed 70 cases to identify cases in which the neurologist and/or urologist suspected the relation between neurological diseases and LUTS. The compromised neurological areas were categorized into brain and spinal cord based on the appearance time of LUTS and presence/absence of disease specificity. We classified the lesion site based on the imaging result and the neurologic finding. We compared LUTS appearance time: from LUTS appearance till the first visit to urologist (first visit urologist) and from the aforementioned visit till the neurological diagnosis confirmation (neurological diagnosis). Finally, we conducted a detailed investigation of the surgical cases, as well as those with urodynamic studies (UDS) performed prior to the neurological examination. RESULTS: The neurological diseases involved 31 cases (44 %) of multiple system atrophy, 11 (16 %) of multiple sclerosis, and 4 (6 %) of Parkinson’s disease. Associated symptoms comprised gait disturbance (38) and lower limb dysesthesia (20), while no associated symptoms were observed in 13 (19 %). Both the periods proved significantly shorter for spinal cord disease. Urological surgeries were performed in 10 cases (14 %). UDS findings revealed 10 cases of decrease in bladder compliance, and 15 of detrusor underactivity; no normal cases were observed. CONCLUSIONS: Consideration of detailed medical history, enforcement of UDS, and closer cooperation between urologists and neurologists are required to ascertain early and correct diagnosis, and to avoid unnecessary surgery.
PMID: 23099558 [PubMed – as supplied by publisher]
Last Updated: July 27, 2020 by uabadmin
Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes.
Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes.:
Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes.
Taiwan J Obstet Gynecol. 2012 Sep;51(3):381-6
Authors: Lin TL, Chen GD, Chen YC, Huang CN, Ng SC
Abstract
OBJECTIVE: The objective of this study was to demonstrate the diversity of urodynamic findings and temporal effects on bladder dysfunction in diabetes as well as to evaluate the predisposing factors that attenuate the storage and voiding function of diabetic women.
MATERIAL AND METHODS: In this prospective study, 181 women with type 2 diabetes mellitus (DM) and lower urinary tract dysfunction underwent complete urogynecological evaluations and urodynamic studies. The patients’ histories of DM and the treatment agents used were documented from chart records and interviews. The urodynamic diagnoses were recategorized into two groups for comparison, namely overactive detrusor (detrusor overactivity and/or increased bladder sensation as well as mixed incontinence) and voiding dysfunction (detrusor hyperactivity with insufficient contractility and detrusor underactivity with poor voiding efficiency) in order to evaluate the temporal effect of DM on diabetic bladder dysfunction.
RESULTS: The development of bladder dysfunction showed a trend involving time-dependent progression, beginning with storage problems (i.e. advancing from urodynamic stress incontinence to detrusor overactivity and/or increased bladder sensation) and eventually led to impaired voiding function. The duration of DM relative to the urodynamic diagnoses of these women was longer in women with voiding dysfunction (6.8 ± 2.8 years with urodynamic stress incontinence, 7.3 ± 6.5 years with detrusor overactivity and/or increased bladder sensation, and 10.4 ± 8.3 years with women with voiding dysfunction). Notwithstanding these findings, stepwise logistic regression analysis indicated that age and recurrent urinary tract infections were the two independent factors associated with developing voiding dysfunction.
CONCLUSION: The urodynamic study revealed a temporal effect on bladder function, and women with diabetic voiding dysfunction were found to have had a longer duration of DM than women with an overactive detrusor. However, aging and recurrent urinary tract infections are the two independent factors that contribute to impaired voiding function and diabetic bladder dysfunction.
PMID: 23040921 [PubMed – in process]
Last Updated: July 27, 2020 by uabadmin
Maximum Isometric Detrusor Pressure to Measure Bladder Strength in Men With Postprostatectomy Incontinence.
Maximum Isometric Detrusor Pressure to Measure Bladder Strength in Men With Postprostatectomy Incontinence.:
Maximum Isometric Detrusor Pressure to Measure Bladder Strength in Men With Postprostatectomy Incontinence.
Urology. 2012 Sep 15;
Authors: Elliott CS, Comiter CV
Abstract
OBJECTIVE: To describe the use of isovolumetric detrusor pressure (Piso) in men with postprostatectomy incontinence and compare the rates of detrusor underactivity using Piso versus other common measurements/surrogates of bladder strength. METHODS: We evaluated 62 men referred to our institution during a 3-year period for workup of postprostatectomy incontinence. During videourodynamic evaluation, the maximum Piso was measured using a mechanical stop test-with the examiner gently occluding the penile urethra during volitional voiding. Statistical analysis was performed to evaluate the effect of patient variables on Piso. RESULTS: The mean Piso was 54.6 ± 25.4 cm H(2)O. The Piso was <50 cm H(2)O in 40%. Isometric strength did not significantly correlate with age, interval since radical prostatectomy, abdominal leak point pressure, maximal urethral closure pressure, or pad use. The bladder contractility index and other approximations of detrusor underactivity were not predictive of low isometric pressure. CONCLUSION: Detrusor underactivity is relatively common in men with postprostatectomy incontinence, with 40% demonstrating a Piso <50 cm H(2)O. Our data do suggest, however, that the use of common bladder contractility nomograms, such as the bladder contractility index, might not be appropriate in this population.
PMID: 22990061 [PubMed – as supplied by publisher]
Last Updated: July 27, 2020 by uabadmin
Clinical symptoms are not reliable in the diagnosis of lower urinary tract dysfunction in women.
Clinical symptoms are not reliable in the diagnosis of lower urinary tract dysfunction in women.:
Clinical symptoms are not reliable in the diagnosis of lower urinary tract dysfunction in women.
J Formos Med Assoc. 2012 Jul;111(7):386-91
Authors: Kuo HC
Abstract
BACKGROUND/PURPOSE: The pathophysiology of female lower urinary tract symptoms (LUTS) may involve bladder, urethral, and pelvic floor dysfunctions. This study analyzed the relationship between clinical symptoms and lower urinary tract dysfunctions (LUTD) in women.
METHODS: A total of 1605 consecutive women were included. LUTS were classified as storage, voiding, pain, and postmicturition symptoms. All patients underwent videourodynamic study (VUDS) and the final diagnosis of LUTD was made based on VUDS findings. Patients were stratified into three major disorder groups: sensory, motor, and bladder outlet disorders. The main symptoms and associated symptoms were used for analysis in varying LUTD.
RESULTS: Normal tracing was found in 272 patients (16.9%), sensory bladder disorders in 459 (28.6%), motor bladder disorders in 560 (34.9%), and bladder outlet disorders were found in 314 patients (19.6%). Frequent urination was the main symptom in patients with normal, bladder oversensitivity, interstitial cystitis, and idiopathic detrusor overactivity (DO). In patients with voiding dysfunction due to detrusor underactivity, bladder neck dysfunction and urethral stricture, dysuria was the most common symptom. However, 707 (44%) of overall women had both storage and voiding symptoms. DO was present in 533 women and in 149 (66%) of 212 with bladder outlet obstruction. However, DO was only found in 42.5% of women with urgency and in 69.4% of women with urgency incontinence based on reported LUTS.
CONCLUSION: Storage and voiding symptoms are common in women with LUTD. The differential diagnosis of LUTD in women cannot be based on LUTS alone.
PMID: 22817816 [PubMed – in process]
Last Updated: July 27, 2020 by uabadmin
The passive and active contractile properties of the neurogenic, underactive bladder.
The passive and active contractile properties of the neurogenic, underactive bladder.:
The passive and active contractile properties of the neurogenic, underactive bladder.
BJU Int. 2012 Jun 19;
Authors: Young JS, Johnston L, Soubrane C, McCloskey KD, McMurray G, Eccles R, Fry CH
Abstract
What’s known on the subject? and What does the study add? Detrusor underactivity is highly prevalent, particularly in the elderly. It is assumed to result from detrusor failure, although detrusor contractility is often derived from urodynamics studies. Given that detrusor pressure and force are not proportional and urodynamics cannot identify the basis of the pathology, we produced a neurogenic animal model with a highly-compliant bladder and studied detrusor muscle properties, aiming to increase our understanding of the underlying pathology. Highly compliant bladders were characterized by reduced passive wall stiffness and stretched detrusor muscle strips exhibited an enhanced rate of relaxation. These detrusor strips displayed spontaneous contractions that were of greater amplitude (expressed as a ratio of bladder wall stiffness) than those of strips from sham-operated animals; spontaneous contractions increased in amplitude when stimulated by an agonist. These data imply that compliance is not the result of a reduction of detrusor contractility; we hypothesize that altered matrix properties reduce the magnitude with which force can be generated to void the bladder. OBJECTIVE: •  To characterize passive and active changes in detrusor activity in a highly compliant bladder. MATERIALS AND METHODS: •  Bladders from adult female Sprague-Dawley rats were used 5 weeks after lower thoracic (T8) spinal cord transection or a sham-operation. •  Passive wall properties were assessed by pressure-volume relationships from whole bladders and the tensile response of bladder strips after a rapid (<0.5 s) stretch. •  Active properties were assessed from the frequency and amplitude of spontaneous contractions of bladder strips, and their response to the inotropic TRPV4 agonist GSK1016790A. RESULTS: •  Passive bladder wall stiffness of SCT bladders was significantly reduced compared to that of the sham-operated control group (N= 6 and 8, respectively) and SCT bladder strips relaxed more quickly than those from sham-operated rats. •  The frequency of spontaneous contractions was reduced in SCT rats, and their amplitude, expressed as a ratio of bladder wall stiffness, was greater than in sham-operated rats. •  GSK1016790A (0.1 µm) significantly increased amplitude in strips from both sham-operated and SCT groups. CONCLUSIONS: •  There is no evidence of contractile failure in a highly-compliant bladder. The observations of reduced passive bladder wall stiffness and an enhanced rate of stress relaxation lead to the conclusion that increased compliance is marked by altered matrix properties that dissipate muscle force, thereby generating low pressures. •  Contractile agonists may be effective for improving bladder function in detrusor underactivity.
PMID: 22712666 [PubMed – as supplied by publisher]
Last Updated: July 27, 2020 by uabadmin
Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women.
Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women.:
Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women.
Korean J Urol. 2012 May;53(5):342-8
Authors: Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM, Oh JJ, Lee SC, Jeong CW, Yoon CY, Hong SK, Byun SS, Lee SE
Abstract
PURPOSE: To identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS).
MATERIALS AND METHODS: We reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) ≤12 ml/s combined with a detrusor pressure at Qmax ≤10 cmH(2)O for men and women, respectively.
RESULTS: Of the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU.
CONCLUSIONS: DU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.
PMID: 22670194 [PubMed – in process]
Last Updated: July 27, 2020 by uabadmin
Persistent vesicourethral dysfunction following radical surgery for rectal carcinoma: urodynamic features and potential abatement with modified sphincterotomy (radical transurethral resection of the prostate).
Persistent vesicourethral dysfunction following radical surgery for rectal carcinoma: urodynamic features and potential abatement with modified sphincterotomy (radical transurethral resection of the prostate).:
Persistent vesicourethral dysfunction following radical surgery for rectal carcinoma: urodynamic features and potential abatement with modified sphincterotomy (radical transurethral resection of the prostate).
Int J Urol. 1998 Jan;5(1):39-43
Authors: Mitsui T, Shinno Y, Kobayashi S, Matsuura S, Shibata T, Ameda K, Koyanagi T
BACKGROUND: Vesicourethral function returns after radical rectal surgery during the first year but rarely progresses after 1 year. We examined the urodynamics of patients whose voiding dysfunction remained after 1 year, and treated several with a modified sphincterotomy procedure similar to radical transurethral resection of the prostate. METHODS: We analyzed the urodynamic features of vesicourethral dysfunction in 16 male patients with persistent voiding dysfunction for more than 1 year following radical surgery for rectal carcinoma. Seven patients elected to undergo radical transurethral resection of prostate (radical TUR-P) for the relief of their persistent voiding dysfunction. RESULTS: The mean bladder volume at the first desire to void was 210 mL, the mean maximal bladder capacity was 343 mL, and the mean vesical compliance (Cves) was 27.1 mL/cm H2O. All patients demonstrated either vesical denervation supersensitivity (Vds) or uninhibited contraction. The mean maximal urethral closure pressure was 43.9 cm H2O, and urethral denervation supersensitivity was found in 77.8% (7/9), and sphincter dyssynergia in 66.7% (6/9) of patients. After radical TUR-P, 5 patients became free from the use of self-catheterization, 1 patient had a reduced residual urine rate, and 1 patient was unchanged, but no patient noted a change in urinary control. CONCLUSION: Urethral dysfunction after radical rectal surgery was caused by failure of the bladder to empty along with an underactive detrusor. Radical TUR-P was effective in restoring voiding function in a selected group of these patients.
PMID: 9535599 [PubMed – indexed for MEDLINE]
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