TY - JOUR
T1 - Pathophysiological mechanisms in detrusor underactivity
T2 - Novel experimental findings
AU - Vale, Luis
AU - Jesus, Filipa
AU - Marcelissen, Tom
AU - Rieken, Malte
AU - Geavlete, Bogdan
AU - Rahnama'i, Mohammad Sajjad
AU - Martens, Frank
AU - Cruz, Francisco
AU - Antunes-Lopes, Tiago
AU - EAU Young Academic Urologists Functional Urology Working Group
N1 - Publisher Copyright:
© 2019 John Wiley & Sons Australia, Ltd
PY - 2019/5
Y1 - 2019/5
N2 - Underactive bladder (UAB) is a multifactorial symptom complex often related to detrusor underactivity (DU). Although recognized as a common cause of lower urinary tract symptoms and with significant effects on quality of life, UAB/DU is largely underresearched. Herein, we review up-to-date knowledge on the pathophysiological mechanisms of UAB/DU, with an emphasis on the relationship between UAB and bladder outlet obstruction (BOO). Original articles and reviews concerning UAB/DU were identified through a search of the PubMed/Medline and Scopus databases. DU can result from several pathological mechanisms, which can be categorized as idiopathic, neurogenic, myogenic, or functional. The main etiological factors of UAB/DU are aging, diabetes mellitus, neurogenic disorders, and BOO. Although conventional models focus primarily on efferent nerve and myogenic mechanisms, contemporary views highlight the importance of the afferent pathway. Specifically, recent findings in BOO showed that afferent dysfunction, such as altered expression of muscarinic and purinergic P2X(3) receptors or diminished urothelial ATP may play a role in the initial and reversible stages of DU, with potential diagnostic and therapeutic implications.
AB - Underactive bladder (UAB) is a multifactorial symptom complex often related to detrusor underactivity (DU). Although recognized as a common cause of lower urinary tract symptoms and with significant effects on quality of life, UAB/DU is largely underresearched. Herein, we review up-to-date knowledge on the pathophysiological mechanisms of UAB/DU, with an emphasis on the relationship between UAB and bladder outlet obstruction (BOO). Original articles and reviews concerning UAB/DU were identified through a search of the PubMed/Medline and Scopus databases. DU can result from several pathological mechanisms, which can be categorized as idiopathic, neurogenic, myogenic, or functional. The main etiological factors of UAB/DU are aging, diabetes mellitus, neurogenic disorders, and BOO. Although conventional models focus primarily on efferent nerve and myogenic mechanisms, contemporary views highlight the importance of the afferent pathway. Specifically, recent findings in BOO showed that afferent dysfunction, such as altered expression of muscarinic and purinergic P2X(3) receptors or diminished urothelial ATP may play a role in the initial and reversible stages of DU, with potential diagnostic and therapeutic implications.
KW - bladder outlet obstruction
KW - detrusor underactivity
KW - lower urinary tract symptoms
KW - pathophysiology
KW - BLADDER OUTLET OBSTRUCTION
KW - GERIATRIC VOIDING DYSFUNCTION
KW - URINARY-TRACT DYSFUNCTION
KW - TERM CALORIC RESTRICTION
KW - STRUCTURAL BASIS
KW - COMMON
KW - MODEL
KW - CONTRACTILITY
KW - EPIDEMIOLOGY
KW - INCONTINENCE
U2 - 10.1111/luts.12257
DO - 10.1111/luts.12257
M3 - (Systematic) Review article
C2 - 30864243
SN - 1757-5664
VL - 11
SP - 92
EP - 98
JO - LUTS-Lower Urinary Tract Symptoms
JF - LUTS-Lower Urinary Tract Symptoms
IS - 3
ER -