Three13 118 Underactive bladder

Underactive bladder: Slow urinary stream, hesitancy and straining to void, with or without a feeling of incomplete bladder emptying sometimes with storage symptoms

Acontractile bladder - that cannot be demonstrated to contract during urodynamic studies


Detrusor underactivity (UDS diagnosis) - contraction of reduced strength and/or duration resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal life span

No specific definition of any of the following descriptive terms - reduced strength on UDS, reduced duration in UDS, prolonged bladder emptying, complete bladder emptying, normal time span?

A contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span - ICS 2002

• Detrusor wall thickness (DWT) ≤ 1.23 mm + bladder capacity >445 ml have DU.
• Combination of these two tests could help physicians to diagnose DU noninvasively in clinical practice. A prospective independent study should confirm these results

[@ 12345 - 1.23, 450ml]]

• Bladder related (increasing intravesical pressure or facilitating bladder contractility) 
• - External compression, Valsalva 
• - Promotion/initiating reflex contraction 
• - Pharmacotherapy 
• - Electrical stimulation
• - Reduction cystoplasty 
• - Bladder myoplasty 

• Outlet related (decreasing outlet resistance) 
• - at the site of obstruction - TURP, TUBNI, urethral stricture repair, intraurethral stent, balloon dilatation 
• - at the level of smooth sphincter - pharmacological therapy, transurethral incision, YV plasty 
• - at the level of striated sphincter - behaviour therapy, biofeedback, pharmacotherapy, urethral over dilatation,m surgical sphincterotomy

• Circumventing the problem 
• - CISC 
• - Indwelling catheterization 
• - Urinary diversion (conduit)

• PVRU 
• Biochemistry 
• Upper tracts 
• Bladder wall thickness