The underactive bladder: diagnosis and surgical treatment options

Area of Science:

• Urology
• Geriatrics

Background:

• Underactive bladder (UAB), also known as detrusor underactivity (DU), is a prevalent condition, particularly in older adults.
• DU affects up to 45% of individuals over 70 and presents diagnostic and management challenges due to symptom overlap with overactive bladder (OAB) and bladder outlet obstruction (BOO).

Purpose of the Study:

• To review the diagnostic approaches for UAB/DU.
• To provide an overview of various surgical treatment options for UAB/DU.

Main Methods:

• A comprehensive literature review was conducted using major medical search engines.
• Keywords included UAB, DU, TURP, reduction cystoplasty, bladder diverticulectomy, and sacral neuromodulation (SNM).
• Relevant literature was assessed for definitions, general overview, and management strategies.

Main Results:

• Urodynamic findings for DU include low voiding pressure, slow flow, and incomplete emptying.
• Transurethral resection of the prostate (TURP) offers feasible short-to-medium term benefits for DU, though symptoms may return.
• Bladder diverticulectomy and sacral neuromodulation (SNM) can improve DU, with patient selection being crucial for SNM success.

Conclusions:

• Effective diagnosis and management of UAB/DU require careful consideration of urodynamic findings and patient characteristics.
• Surgical interventions like TURP, bladder diverticulectomy, and SNM present viable options, each with specific indications and outcomes.
• Optimizing patient selection is key to achieving successful outcomes with surgical treatments for UAB/DU.