Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women

Seong Jin Jeong, Hyeon June Kim, Young Ju Lee, Jeong Keun Lee, Byung Ki Lee, Young Min Choo, Jong Jin Oh, Sang Cheol Lee, Chang Wook Jeong, Cheol Yong Yoon, Sung Kyu Hong, Seok-Soo Byun, Sang Eun Lee, Seong Jin Jeong, Hyeon June Kim, Young Ju Lee, Jeong Keun Lee, Byung Ki Lee, Young Min Choo, Jong Jin Oh, Sang Cheol Lee, Chang Wook Jeong, Cheol Yong Yoon, Sung Kyu Hong, Seok-Soo Byun, Sang Eun Lee

Abstract

Purpose: To identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS).

Materials and methods: We reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) ≤12 ml/s combined with a detrusor pressure at Qmax ≤10 cmH(2)O for men and women, respectively.

Results: Of the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU.

Conclusions: DU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.

Keywords: Aged; Prevalence; Urinary bladder; Urination disorders; Urodynamics.

Conflict of interest statement

The authors have nothing to disclose.

Figures

FIG. 1
FIG. 1
Prevalence of detrusor underactivity by age group. Prevalence of detrusor underactivity increased with age (p=0.053 and 0.002 in men and women, respectively).
FIG. 2
FIG. 2
Prevalence of detrusor underactivity, detrusor overactivity, bladder outlet obstruction, and urodynamic stress urinary incontinence by age group. (A) In men, prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum but prevalence of detrusor underactivity (DU) and detrusor overactivity (DO) increased with age. (B) In women, prevalence of urodynamic stress urinary incontinence (USUI) decreased and the prevalence of DU, DO, BOO increased with age.
FIG. 3
FIG. 3
Combined urodynamic diagnosis in the subjects with detrusor underactivity. M, men; F, women; DU, detrusor underactivity; DO, detrusor overactivity; BOO, bladder outlet obstruction; USUI, urodynamic stress urinary incontinence.

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