The bladder of willful infrequent voiders: underactive or underutilized?

Area of Science:

• Pediatric Urology
• Lower Urinary Tract Dysfunction

Background:

• Detrusor underutilization disorder (DUD) is a lower urinary tract condition characterized by chronic or episodic willful deferment of voiding.
• DUD results in an expanded bladder capacity in patients experiencing lower urinary tract symptoms (LUTS).

Purpose of the Study:

• To further characterize pediatric patients diagnosed with detrusor underutilization disorder (DUD).
• To analyze the clinical presentation and urodynamic findings of children with DUD.

Main Methods:

• Retrospective database review of neurologically and anatomically normal children diagnosed with DUD.
• Inclusion criteria required bladder capacity >125% of estimated bladder capacity (EBC) for age.
• Analysis of lower urinary tract symptoms (LUTS), voiding diaries, and uroflowmetry with electromyography (EMG) findings.

Main Results:

• Fifty-five children (mean age 10.5 years) were diagnosed with DUD.
• Common presenting symptoms included incontinence (43.6%), urinary tract infections (UTIs) (49.1%), and urgency (30.9%).
• Mean %EBC decreased from 1.67 to 1.10 following treatment.

Conclusions:

• DUD patients commonly present with infrequent voiding, incontinence, urgency, and UTIs.
• Compared to overactive bladder and dysfunctional voiding, DUD patients exhibit less bowel dysfunction and frequency, with larger bladder capacities.
• DUD is proposed as a distinct diagnosis, despite symptom overlap with "underactive bladder" and "voiding postponement" concepts.