Underactive Bladder Syndrome: An Often Overlooked Condition

Abstract

Urinary bladder outlet obstruction can cause lower urinary tract symptoms in men and women, such as a weak or interrupted urine stream, straining to void, hesitancy, and the feeling of incomplete bladder emptying. These symptoms can also be associated with underactive bladder syndrome. This urological condition has a high prevalence in both genders, especially in older age groups. The most common risk factors that can contribute to the pathogenesis of underactive bladder syndrome are aging, detrusor myopathy, neuroinflammatory, neurodegenerative and other lesions of the central and peripheral nervous system, and diabetes mellitus. Reduced detrusor contractility, or detrusor underactivity, is the most common pathology of underactive bladder syndrome. Detrusor underactivity is a urodynamic definition provided by the International Continence Society. The urodynamic trace is characterised by a low urine flow rate accompanied by low detrusor pressure or brief detrusor muscle contraction. Underactive bladder syndrome is often recognised and treated poorly in clinical practice because the symptoms are not specific. Furthermore, underactive bladder can be asymptomatic or coexist with bladder outlet obstruction and overactive bladder syndrome. The aim of this study was to review recent research concerning the aetiology, classification, diagnostic evaluation, and available treatment methods for patients with symptoms of underactive bladder syndrome. Making an accurate underactive bladder diagnosis is challenging because it is a multifactorial condition with various patterns of manifestation. Consequently, there is still no general agreement and standardisation regarding the most favourable diagnostic and therapeutical approach.