Underactive bladder ICS 2018 definition?
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?
What is detrusor underactivity?
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
USG finding in detrusor underactivity?
- 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]]
Treatment of detrusor underactivity?
- 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)
Monitoring the patient with DU?
- Upper tracts
- Bladder wall thickness