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Underactive Bladder - an Underestimated Entity Journal of Mind and Medical Sciences Volume 7 Issue 1 Article 5 2020 Underactive bladder - an underestimated entity Spinu Arsenie Dan CAROL DAVILA UNIVERSITY OF MEDICINE AND PHARMACY, BUCHAREST, ROMANIA Ovidiu Gabriel Bratu CAROL DAVILA UNIVERSITY OF MEDICINE AND PHARMACY, BUCHAREST, ROMANIA Dragos Radu Marcu CAROL DAVILA UNIVERSITY OF MEDICINE AND PHARMACY, BUCHAREST, ROMANIA Adina Elena Stanciu INSTITUTE OF ONCOLOGY BUCHAREST, DEPARTMENT OF CARCINOGENESIS AND MOLECULAR BIOLOGY, BUCHAREST, ROMANIA Florentina Gherghiceanu CAROL DAVILA UNIVERSITY OF MEDICINE AND PHARMACY, BUCHAREST, ROMANIA See next page for additional authors Follow this and additional works at: https://scholar.valpo.edu/jmms Part of the Psychiatry Commons, and the Urology Commons Recommended Citation Dan, Spinu Arsenie; Bratu, Ovidiu Gabriel; Marcu, Dragos Radu; Stanciu, Adina Elena; Gherghiceanu, Florentina; Ionita-Radu, Florentina; Bungau, Simona; Stanescu, Ana Maria Alexandra; and Mischianu, Dan (2020) "Underactive bladder - an underestimated entity," Journal of Mind and Medical Sciences: Vol. 7 : Iss. 1 , Article 5. DOI: 10.22543/7674.71.P2328 Available at: https://scholar.valpo.edu/jmms/vol7/iss1/5 This Review Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at [email protected]. Underactive bladder - an underestimated entity Authors Spinu Arsenie Dan, Ovidiu Gabriel Bratu, Dragos Radu Marcu, Adina Elena Stanciu, Florentina Gherghiceanu, Florentina Ionita-Radu, Simona Bungau, Ana Maria Alexandra Stanescu, and Dan Mischianu This review article is available in Journal of Mind and Medical Sciences: https://scholar.valpo.edu/jmms/vol7/iss1/5 Journal of Mind and Medical Sciences https://scholar.valpo.edu/jmms/ https://proscholar.org/jmms/ I S S N : 2 3 9 2 - 7 6 7 4 Underactive bladder - an underestimated entity Spinu Arsenie Dan1,2, Ovidiu Gabriel Bratu1,2,3, Dragos Radu Marcu1,2, Adina Elena Stanciu4, Florentina Gherghiceanu1, Florentina Ionita-Radu5, Simona Bungau6, Ana Maria Alexandra Stanescu1, Dan Mischianu1,2,3 1 CAROL DAVILA UNIVERSITY OF MEDICINE AND PHARMACY, BUCHAREST, ROMANIA 2 UNIVERSITY EMERGENCY CENTRAL MILITARY HOSPITAL, DEPARTMENT OF UROLOGY, BUCHAREST, ROMANIA 3 ACADEMY OF ROMANIAN SCIENTISTS, BUCHAREST, ROMANIA 4 INSTITUTE OF ONCOLOGY BUCHAREST, DEPARTMENT OF CARCINOGENESIS AND MOLECULAR BIOLOGY, BUCHAREST, ROMANIA 5 UNIVERSITY EMERGENCY CENTRAL MILITARY HOSPITAL, DEPARTMENT OF GASTROENTEROLOGY, BUCHAREST, ROMANIA 6 UNIVERSITY OF MEDICINE AND PHARMACY, ORADEA, ROMANIA ABSTRACT Introduction. The concept of underactive bladder is relatively new. Currently there is no generally accepted definition of this pathology. Diagnosis Category: Review depends on urodynamic findings, and symptoms are usually rare and Received: October 12, 2019 intricated with the symptoms of other urinary pathology. Accepted: February 16, 2020 Matherials and methods. This review examines the current literature on Keywords: underactive bladder regarding pathology, definition, diagnosis, current underactive bladder, detrusor underactivity, diagnosis, guidelines, and any further potential medical developments. treatment Conclusions. Underactive bladder is a poorly understood pathologic *Corresponding author: condition. Only since 2002 has there been any consensus regarding the Dragos Radu Marcu, Carol Davila University of Medicine definition. The diagnosis relies only on urodynamics; clinical diagnosis is a and Pharmacy, Bucharest, Romania E-mail: [email protected] challenge even for a consultant; and treatment does not seem to alleviate much of the suffering. This disease remains underrecognized and undertreated. More research is needed to identify less invasive diagnosis tools and treatment for this pathology. Introduction For years, this condition has been overlooked. Its counterpart, the overactive bladder, had received much In 2002, the International Continence Society reviewed greater research interest, perhaps due to its more intrusive the existing data and arrived at a definition for underactive symptomatology. bladder: ‘a contraction of reduced strength and/or duration, The pathology has borne many names: impaired resulting in prolonged bladder emptying and/or failure to detrusor contractility, bladder failure, bladder achieve complete bladder emptying within a normal time decompensation, hypotonic bladder, detrusor areflexia, span’. However, the definition for this pathology had been and detrusor failure and detrusor underactivity, although evolving over some time. For instance, in 1996 the some authors suggest the last one represents its own International Continence Society defined underactive category, a point subject to debate [2-4]. bladder as failure to induce emptying of at least half of the The diagnosis for this disease relies mostly on bladder with involuntary recurrent contractions without the urodynamic findings. The prevalence increases with age evidence of straining, urethral obstruction, and detrusor and is typically greater in men. Prevalence ranges from 9 sphincter dyssynergia. After the 2002 definition was to 28% in men under 50 years old and more than 48% in presented (above), in 2010, the society revised the those over 70 years old. In women, the incidence ranges definition as a decrease in detrusor contraction and/or from 12 to 45% [5,6]. Yet, no consensus exists for shortening of the contraction time, resulting in an threshold urodynamic values for disease categorization. incomplete and/or prolongation of the bladder emptying Although various papers have proposed different within the normal time frame [1]. thresholds, no widely accepted guidelines currently exist. To cite this article: Spinu Arsenie Dan, Ovidiu Gabriel Bratu, Dragos Radu Marcu, Adina Elena Stanciu, Florentina Gherghiceanu, Florentina Ionita-Radu, Simona Bungau, Ana Maria Alexandra Stanescu, Dan Mischianu. Underactive bladder - an underestimated entity. J Mind Med Sci. 2020; 7(1): 23-28. DOI: 10.22543/7674.71.P2328 Spinu Arsenie Dan et al. Discussions investigations, as 12,7% of patients with underactive bladder were mistakenly treated with anticholinergics [16]. A comprehensive search of PubMed, Scopus, and other databases was conducted using key words like Patients presenting with overactive bladder and "underactive bladder, detrusor underactivity". Review receiving some form of treatment may change at some articles were selected. Several older papers were included point in their pathology, and an overstimulated bladder can for citations and historic interest. Prevalence, etiology, become hypotonic. Moreover, overactive bladder, bladder diagnosis, and treatment possibilities were searched. The outlet obstruction, and underactive bladder can coexist, purpose of this paper is to highlight the cardinal aspects of making it difficult to treat. In diabetes, the first process is this pathology. bladder hypertrophy with increased contractility, which leads to polyuria. The second stage is linked with Etiology hyperglycemic status which leads to the development of The etiology of this disease is wide and may be toxic metabolites which affect normal bladder function and separated into five broad categories: idiopathic - young promote the detrusor muscle dysfunction. In the end stage, patients with no apparent affections; myogenic - any both mechanisms will lead to an atonic bladder. Chronic subvesical obstacle and diabetes, autonomic diabetic hyperglycemic status induces chronic oxidative stress and neuropathy [7], Parkinson disease, different types of releases reactive oxygen species. This partially explains the sclerosis, disc hernias [8]; spinal cord injury, spinal pathophysiology of diabetic bladder dysfunction, dysraphism and stenosis; infectious - HIV, herpes zoster, especially damaging neuronal fibers, smooth muscles, and herpes simplex and neurosyphilis; and last iatrogenic - altering urothelial function [17-19]. Recognized clinical pelvic surgery, radical prostatectomy, radical hysterectomy risk factors include age, indwelling urinary catheter, [9-11]. In diabetes, chronic hyperglycemic status induces a diabetes, history of urinary retention, and neurologic series of tissues and organ damages. Microvascular conditions [20-26]. involvements in diabetic patients are more common; Still, many useful tools besides urodynamics are retinopathy, neuropathy, and chronic kidney disease are the available to help recognize this condition. A thorough main complications in diabetes. Autonomic diabetic anamnesis from the patient is mandatory in order to neuropathy develops a series of urological sequelae like identify any risk factors for this pathology. A voiding diary erectile dysfunction, retrograde ejaculation, and diabetic is useful to determine the severity of the symptoms; a bladder dysfunction. More than half of diabetic patients neurological exam should also be conducted. The Schaefer develop diabetic bladder dysfunction, and clinical signs are nomogram or a comparable tool may be used to measure described as a triad, including a bladder sensation decrease, obstruction and detrusor contractility [27]. bladder capacity increase, and imperfect detrusor contractility [12]. Moreover, modifications appear at the Efforts are ongoing to identify and standardize different urothelium level: decreases in E- cadherin levels and clinical tools that can differentiate this pathology
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