Pathophysiological mechanisms in detrusor underactivity: Novel experimental findings

Area of Science:

• Urology
• Pathophysiology
• Lower Urinary Tract Symptoms

Background:

• Underactive bladder (UAB) and detrusor underactivity (DU) are common causes of lower urinary tract symptoms, significantly impacting quality of life.
• Despite their prevalence, UAB/DU remains an underresearched area in urology.
• Understanding the pathophysiology is crucial for developing effective treatments.

Purpose of the Study:

• To review current knowledge on the pathophysiological mechanisms of UAB/DU.
• To emphasize the relationship between UAB and bladder outlet obstruction (BOO).
• To highlight emerging roles of the afferent pathway in DU.

Main Methods:

• A comprehensive literature search was conducted using PubMed/Medline and Scopus databases.
• Included original articles and reviews focusing on UAB/DU.
• Synthesized information on etiological factors and pathophysiological pathways.

Main Results:

• Detrusor underactivity (DU) can arise from idiopathic, neurogenic, myogenic, or functional causes.
• Key etiological factors include aging, diabetes mellitus, neurogenic disorders, and bladder outlet obstruction (BOO).
• Recent research indicates afferent pathway dysfunction, including altered receptor expression and urothelial ATP levels, plays a role in early-stage DU, especially secondary to BOO.

Conclusions:

• Contemporary understanding of DU increasingly emphasizes the role of the afferent pathway, moving beyond traditional efferent and myogenic models.
• Afferent dysfunction in the context of BOO presents potential diagnostic and therapeutic targets for UAB/DU.
• Further research into the afferent pathway could unlock novel strategies for managing UAB/DU.