The Underactive Bladder: Diagnosis and Surgical Treatment Options

Overview

Journal Transl Androl Urol

Date 2017 Aug 10

PMID 28791238

Citations 11

Authors

Johan Gani

Derek Hennessey

Affiliations

Soon will be listed here.

Abstract

The underactive bladder (UAB)/detrusor underactivity (DU) is a relatively common condition. It is difficult to diagnose and can be difficult to manage. The aim of this review is to provide a review of the diagnosis and different surgical treatment options for UAB/DU. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, UAB, DU, TURP, reduction cystoplasty, bladder diverticulectomy and sacral neuromodulation (SNM). Search results were assessed for their overall relevance to this review. Definitions, general overview and management options were extracted from the relevant medical literature. DU affects up to 45% of men and women >70 years of age. The symptoms of DU overlap significantly with overactive bladder (OAB) and bladder outlet obstruction (BOO). Urodynamic findings include low voiding pressure combined with slow intermittent flow and incomplete bladder emptying. Non-operative management for DU is acceptable; only 1 in 6 male patients may need a TURP and acute urinary retention (AUR) is rare. TURP for DU is feasible and is associated with good short and medium term outcomes, but over time, there is a return to baseline symptoms. Bladder diverticulectomy can also improve DU, but there is a paucity of guidelines on patient selection. SNM provides excellent outcomes for DU, but patient selection is important.

Citing Articles

Analysis of clinical efficacy of sacral magnetic stimulation for the treatment of detrusor underactivity.

Pan H, Tang C, Song C, Li J Front Neurol. 2025; 16:1499310.

PMID: 40070670 PMC: 11893392. DOI: 10.3389/fneur.2025.1499310.

An Alternative Approach for Treating Female Underactive Bladders with Chronic Urine Retention: A Pilot Study on Combined Transvaginal Ultrasound-Guided Botulinum Toxin A External Sphincter Injection and Transurethral Incision of the Bladder Neck.

Huang W, Tsai C, Chou E Toxins (Basel). 2024; 16(10).

PMID: 39453217 PMC: 11510944. DOI: 10.3390/toxins16100441.

Electrical stimulation for the hypocontractile bladder.

Nassiri N, Schafrank L, Chen M, Burg M, Nitti V Nat Rev Urol. 2024; .

PMID: 39349947 DOI: 10.1038/s41585-024-00949-w.

Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate.

Lombardo R, Ghezzo N, Sarcinelli L, Turchi B, Zammitti F, Franco A Life (Basel). 2024; 14(4).

PMID: 38672716 PMC: 11051523. DOI: 10.3390/life14040445.

Development of a predictive tool for sacral nerve modulation implantation in the treatment of non-obstructive urinary retention and/or slow urinary stream: a study from the Neuro-Urology Committee of the French Association of Urology.

Nasri J, Al Ashimi I, Tricard T, Fleury R, Matta I, Bey E World J Urol. 2023; 41(11):3075-3082.

PMID: 37783844 DOI: 10.1007/s00345-023-04638-y.

References

Ghalayini I, Al-Ghazo M, Pickard R . A prospective randomized trial comparing transurethral prostatic resection and clean intermittent self-catheterization in men with chronic urinary retention. BJU Int. 2005; 96(1):93-7. DOI: 10.1111/j.1464-410X.2005.05574.x. View

van Voskuilen A, Oerlemans D, Weil E, de Bie R, Van Kerrebroeck P . Long term results of neuromodulation by sacral nerve stimulation for lower urinary tract symptoms: a retrospective single center study. Eur Urol. 2006; 49(2):366-72. DOI: 10.1016/j.eururo.2005.11.009. View

Gross C, Habli M, Lindsell C, South M . Sacral neuromodulation for nonobstructive urinary retention: a meta-analysis. Female Pelvic Med Reconstr Surg. 2012; 16(4):249-53. DOI: 10.1097/SPV.0b013e3181df9b3f. View

Osman N, Chapple C, Abrams P, Dmochowski R, Haab F, Nitti V . Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2013; 65(2):389-98. DOI: 10.1016/j.eururo.2013.10.015. View

Tanaka Y, Masumori N, Itoh N, Furuya S, Ogura H, Tsukamoto T . Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity?. Int J Urol. 2006; 13(11):1398-404. DOI: 10.1111/j.1442-2042.2006.01589.x. View

Thomas A, Cannon A, Bartlett E, Ellis-Jones J, Abrams P . The natural history of lower urinary tract dysfunction in men: minimum 10-year urodynamic follow-up of untreated bladder outlet obstruction. BJU Int. 2005; 96(9):1301-6. DOI: 10.1111/j.1464-410X.2005.05815.x. View

Leng W, Chancellor M . How sacral nerve stimulation neuromodulation works. Urol Clin North Am. 2005; 32(1):11-8. DOI: 10.1016/j.ucl.2004.09.004. View

Kim D . Origin of Urgency Symptom in Underactive Bladder: Commentary on "Underactive Bladder: Clinical Features, Urodynamic Parameters, and Treatment" (Int Neurourol J 2015;19:185-9). Int Neurourol J. 2016; 19(4):293-4. PMC: 4703938. DOI: 10.5213/inj.2015.19.4.293. View

Shaker H, Hassouna M . Sacral root neuromodulation in idiopathic nonobstructive chronic urinary retention. J Urol. 1998; 159(5):1476-8. DOI: 10.1097/00005392-199805000-00017. View

10.

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U . The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol. 2002; 187(1):116-26. DOI: 10.1067/mob.2002.125704. View

11.

Golijanin D, Yossepowitch O, Beck S, Sogani P, Dalbagni G . Carcinoma in a bladder diverticulum: presentation and treatment outcome. J Urol. 2003; 170(5):1761-4. DOI: 10.1097/01.ju.0000091800.15071.52. View

12.

Jonas U, Fowler C, Chancellor M, Elhilali M, Fall M, Gajewski J . Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol. 2000; 165(1):15-9. DOI: 10.1097/00005392-200101000-00004. View

13.

Goh M, Diokno A . Sacral neuromodulation for nonobstructive urinary retention--is success predictable?. J Urol. 2007; 178(1):197-9. DOI: 10.1016/j.juro.2007.03.058. View

14.

Rule A, Lieber M, Jacobsen S . Is benign prostatic hyperplasia a risk factor for chronic renal failure?. J Urol. 2005; 173(3):691-6. DOI: 10.1097/01.ju.0000153518.11501.d2. View

15.

Panicker J, Fowler C, Kessler T . Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol. 2015; 14(7):720-32. DOI: 10.1016/S1474-4422(15)00070-8. View

16.

van Kerrebroeck P, van Voskuilen A, Heesakkers J, Lycklama a Nijholt A, Siegel S, Jonas U . Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007; 178(5):2029-34. DOI: 10.1016/j.juro.2007.07.032. View

17.

Hoag N, Gani J . Underactive Bladder: Clinical Features, Urodynamic Parameters, and Treatment. Int Neurourol J. 2015; 19(3):185-9. PMC: 4582091. DOI: 10.5213/inj.2015.19.3.185. View

18.

Thorner D, Blaivas J, Tsui J, Kashan M, Weinberger J, Weiss J . Outcomes of reduction cystoplasty in men with impaired detrusor contractility. Urology. 2014; 83(4):882-6. DOI: 10.1016/j.urology.2013.10.068. View

19.

Datta S, Chaliha C, Singh A, Gonzales G, Mishra V, Kavia R . Sacral neurostimulation for urinary retention: 10-year experience from one UK centre. BJU Int. 2007; 101(2):192-6. DOI: 10.1111/j.1464-410X.2007.07282.x. View

20.

Gepi-Attee S, Feneley R . Bladder diverticulectomy revisited: case reports of retention of urine caused by diverticula and discussion. J Urol. 1994; 152(3):954-5. DOI: 10.1016/s0022-5347(17)32621-6. View