Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Underactive bladder

Definition
UAB, also known as detrusor underactivity, is characterized by reduced strength and/or duration of bladder contractions, leading to incomplete bladder emptying or prolonged urination.
1
Pathophysiology
The pathophysiology of UAB is complex and involves both myogenic and neurogenic mechanisms. Myogenic failure refers to a dysfunction in the detrusor muscle, which is responsible for bladder contractions. Neurogenic mechanisms involve dysfunctions in the efferent and/or afferent nerves that control bladder function, as well as potential CNS dysfunction.
3
4
Epidemiology
The prevalence of detrusor underactivity in elderly patients with bothersome LUTS is reported to be 25-48% in men and 12-24% in women.
2
Disease course
Clinically, UAB is characterized by a slow urinary stream, hesitancy, and straining to void, leading to prolonged urination time with or without a feeling of incomplete bladder emptying. Storage LUTS, such as nocturia, are also common.
1
4
Prognosis and risk of recurrence
The prognosis of UAB can vary widely, but it is generally a chronic and progressive condition. Complications such as urinary retention and UTIs can further impact the prognosis.
1
Key sources
The following summarized guidelines for the management of underactive bladder are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2023).
1
2
3
4
5
6

Guidelines

1.Medical management

Alpha-blockers: offer alpha-blockers before more invasive techniques.
B
Create free account

More topics in this section

  • Parasympathomimetics

2.Therapeutic procedures

Urinary catheterization
Offer clean intermittent self-catheterization as a standard treatment in patients unable to empty their bladder. Instruct patients thoroughly on the technique and risks of clean intermittent self-catheterization.
A
Offer indwelling transurethral catheterization and suprapubic cystostomy only when other modalities for urinary drainage have failed or are unsuitable.
B

More topics in this section

  • Intravesical prostaglandins

  • Intravesical electrical stimulation

  • Botulinum toxin injections

  • Sacral nerve stimulation

3.Surgical interventions

Detrusor myoplasty: do not offer detrusor myoplasty routinely for the treatment of detrusor underactivity.
D

4.Patient education

General counseling
Encourage double voiding in patients unable to completely empty their bladder.
B
Counsel female patients with UAB using abdominal straining to improve emptying regarding the risk of pelvic organ prolapse.
B