Abstract
Purpose
To describe the clinical presentation and urodynamic findings in detrusor underactivity (DU) patients and investigate the association between DU and straining related complications such as pelvic organ prolapse (POP), inguinal hernia, and hemorrhoids.
Methods
We retrospectively reviewed all consecutive patients who underwent urodynamic studies (UDS) from 2012 to 2023, divided into two groups: those with evidence of DU (n = 573), and control subjects with normal voiding parameters (n = 522). Exclusion criteria were patients who lacked sufficient data, those with obstructive voiding parameters and those who had received intravesical botulinum toxin injections within the previous nine months. Demographic information, clinical presentation, straining related complications and UDS findings were compared between the two groups using univariate statistical analysis.
Results
Median age in the DU group was 67. The DU group had a statistically significant higher prevalence of spinal disease, multiple sclerosis, previous cerebrovascular accidents, previous colorectal surgery, previous transabdominal gynecological surgery, POP surgery, and recurrent UTIs. DU patients had a higher prevalence of pronounced vaginal bulging symptoms, inguinal hernia, and hemorrhoids. Poor stream was the most common lower urinary tract symptom (50.5%). The median Qmax, PdetQmax, and PVR for DU patents were 7 ml/sec, 13 cmH2O, and 200 ml, respectively.
Conclusion
DU patients commonly present with both voiding and storage symptoms. There is approximately twice the risk of having POP surgery and inguinal hernia, a seven-fold risk of hemorrhoids, and a three-fold risk of recurrent UTIs. This is thought to be secondary to increased intra-abdominal pressure during urinary straining.