Underactive bladder and detrusor underactivity: a review of pathophysiology and management strategies for this poorly understood bladder syndrome

The International Continence Society (ICS) defines underactive bladder (UAB) as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span. UAB is observed in many conditions and is not just part of normal aging process. Patients with UAB have a diminished sensation of when the bladder is full and are unable to contract the muscles sufficiently to empty the bladder completely. Urodynamic study is currently the only definitive method of assessing detrusor contractile function. Conservative strategies include scheduled void, straining to void, and the use of indwelling/intermittent catheterization. The current pharmacotherapy aims at decreasing the bladder outlet and promoting bladder contractility, while neuromodulation and intravesical electrical stimulation may play a role in selected patients. Future therapy in UAB is likely stem cells regenerative technology, and gene therapy in bladder regeneration and return of normal bladder contractility