Prevalence and urodynamic characteristics of detrusor overactivity with impaired contractility in the community-dwelling elderly with non-neurogenic lower urinary tract symptoms: Is it from a single or two independent bladder dysfunctions?

Is detrusor overactivity with detrusor underactivity limited to the elderly?

OBJECTIVE

Detrusor overactivity with detrusor underactivity (DO-DU) is classically described in frail institutionalized elderly patients, but we have also observed this diagnosis in younger populations. This research aims to identify the differences between two age groups of DO-DU patients.

MATERIALS AND METHODS

This study included DO-DU patients from a single center from 2012 to 2023. Patients were divided into two groups: the "Younger" group (aged less than 70 years) and the "Older" group (aged 70 years or older). We separately compared demographics, the number of risk factors considered to affect bladder function, clinical presentations, and urodynamic findings between these two groups in each gender.

RESULTS

There were 210 patients included in the analysis, with 50.48% in the younger group and 49.52% in the older group. The median ages of males and females in the younger group were 57 and 62 years, whereas the median ages of males and females in the older group were 76.5 and 76 years. Multiple sclerosis exhibited statistically significant prevalence in the younger patients (7.7% vs. 0%, p = 0.03 in males and 19.9% vs. 4.6% in females). While diabetes mellitus (DM) was more prevalent in the older males (20.0% vs. 4.6%, p = 0.01), transabdominal hysterectomy was more common in the younger females (46.3% vs. 25%, p = 0.04). 69.8% of the younger group and 71.2% of the older group have at least one risk factor that impact their bladder function. There was no statistically significant difference between the two groups across various risk factor categories. The older males reported a higher incidence of urgency (78.3% vs. 58.5%, p = 0.02) and urge incontinence (61.7% vs. 32.3%, p < 0.01), while the younger females reported a higher incidence of straining during voiding on history (46.3% vs. 20.5%, p = 0.01). The younger males exhibited a greater volume of strong desire to void (385 vs. 300 mL, p = 0.01), maximal cystometric capacity (410 vs. 300 mL, p < 0.01), and a lower highest detrusor overactivity (DO) pressure (37 vs. 50.5 cmH2O, p = 0.02). The younger group had a higher postvoid residual (170 vs. 85 mL in males, p < 0.01 and 180 vs. 120 mL in females, p = 0.02). The voiding efficiency was lower in younger females (40% vs. 60%, p = 0.02). In both ages, the ICS detrusor contraction index and projected isovolumetric pressure 1 were similar. However, without considering risk factors, the older males had the highest DO pressure (57 vs. 29 cmH2O, p < 0.01), and the younger males had a higher voiding pressure (PdetQmax) than the older males (28 vs. 20 cmH2O, p = 0.02).

CONCLUSION

DO-DU is not exclusive to elderly patients. It can also be diagnosed in individuals with risk factors regardless of age; therefore, clinicians need a high degree of suspicion, especially in patients who have risk factor(s) for DO and DU. A notable clinical differentiation is that older males diagnosed with DO-DU have a higher incidence of urgency and urge urinary incontinence, while younger females have a higher incidence of straining.

Systematic review and meta-analysis of urinary incontinence prevalence and population estimates

INTRODUCTION

Incontinence impacts the quality-of-life of people suffering from the disease. However, there is limited information on the prevalence of incontinence due to the stigma, lack of awareness, and underdiagnosis.

OBJECTIVE

This study aims to conduct a systematic review and meta-analysis of overactive bladder (OAB) and nonobstructive urinary retention (NOUR).

METHODS

The authors conducted a systematic review following the PRISMA guidelines using Embase, MEDLINE, and PubMed databases to identify the relevant publications in the English language. Two reviewers independently assessed the articles and extracted the data. Review papers were assessed for content and references. A meta-analysis of proportions was conducted using the RStudio software. To address the age heterogeneity, a subanalysis was conducted. Pooled data were overlayed on the Canadian population and a sample of 10 populous countries to estimate the number of people suffering from incontinence.

RESULTS

Twenty-eight and eight articles were selected for OAB and NOUR, respectively. The pooled prevalence of OAB in men and women was 12% (95% CI: 9%-16%) and 15% (95% CI: 12%-18%), respectively. The estimated prevalence of NOUR was 15.6%-26.1% of men over 60 and 9.3%-20% of women over 60. The subanalysis pooled prevalence of OAB in men and women was 11% (95% CI: 8%-15%) and 12% (95% CI: 9%-16%), respectively. We estimated that 1.4-2.5 million women and 1.3-2.2 million men suffer from OAB in Canada.

CONCLUSION

Urinary incontinence is an under-reported and underdiagnosed prevalent condition that requires appropriate treatment to improve a patient's quality-of-life.

Two types of detrusor underactivity in men with nonneurogenic lower urinary tract symptoms

AIMS

To clarify the clinical features of men with nonneurogenic detrusor underactivity (DU) by focusing on storage dysfunction (SD).

METHODS

We retrospectively reviewed the clinical and urodynamic data of men with nonneurogenic DU. Patients were divided into two groups according to the presence or absence of SD, such as detrusor overactivity (DO) and reduced bladder compliance (BC). Patient characteristics, lower urinary tract symptoms (LUTS), and urodynamic parameters were compared. DU was defined as bladder contractility index (BCI) ≤ 100 and bladder outlet obstruction index (BOOI) ≤ 40.

RESULTS

Of 212 men with DU, 123 (58.0%) had concomitant SD (SD + DU group), and 89 (42.0%) had only DU (DU-only group). Age, prostate volume, and severity of storage symptoms were significantly higher in the SD + DU group. Particularly, >80% of men in the SD + DU group met the diagnostic criteria for overactive bladder in Japan, which was significantly higher than the 26% of men in the DU-only group. The frequency of urinary urgency incontinence (UUI) was also significantly higher in the SD + DU group (65% vs. 12% in DU-only group). In contrast, voiding symptoms, including straining, were more severe in the DU-only group. Regarding the urodynamic parameters, compared to the DU-only group, bladder capacity was significantly smaller and BOOI and BCI were significantly higher in the SD + DU group. However, there was no significant difference in the maximum flow rate and bladder voiding efficiency.

CONCLUSIONS

Approximately 60% of men with DU had SD, such as DO and/or reduced BC, whereas the remaining 40% had increased bladder capacity without an increase in detrusor pressure during the storage phase. There were significant differences in the storage and voiding symptoms between the groups. It is important to divide patients with DU based on SD to accurately clarify the clinical picture of DU.

Urodynamic characteristics of adult men with mixed detrusor overactivity with detrusor underactivity: A database analysis

Objective:

To examine the urodynamic characteristics of men with mixed detrusor overactivity with detrusor underactivity (DODU) across the entire adult-age spectrum.

Materials and Methods:

Data included all adult men who underwent urodynamics for refractory non-neurogenic lower tract symptoms between 2011 and 2019. DODU was defined as the concomitant presence of detrusor overactivity (DO) during storage with underactivity (bladder contractility index, BCI < 100) during voiding. Nonparametric tests with multiple hypothesis correction were used (SPSS 25.0).

Results:

DODU was noted in 199/1596 men (12.5%; median, 62 years). Men with DODU were older than men with detrusor underactivity (DU) or DO alone (median, 62, 48 and 56 years, respectively). DODU was commoner in older men but was noted across all age groups. As compared to men with isolated DU, men with DODU were more likely to be obstructed (38.7% versus 23.6%) and had better contractility (median BCI 81 versus 75). Peak detrusor contraction pressure during overactivity was lower in men with DODU than men with isolated DO.

Conclusion:

DODU should not be regarded as an exclusively geriatric disease. Differences in urodynamic characteristics suggest that this condition might not just be the coincidental occurrence of DO and underactivity in the same individual.

Level of evidence:

III