Detrusor underactivity in older adults appears to gradually worsen over time with no effective treatments, investigators reported at the International Continence Society’s 2022 annual meeting (ICS 2022) in Vienna, Austria.
Investigators conducted a prospective 10-year follow-up study that included 327 older adults with a mean age of 73.3 years with idiopathic detrusor underactivity. They defined detrusor underactivity as a bladder contractility index of less than 100 in male patients and a maximum flow rate (Qmax) of 12 mL/s or less combined with a detrusor pressure at Qmax of 10 cm H20 or less in female patients. Among men, mean bladder contractility was 78.1. Among women, mean Qmax was 10.2 mL/s, and mean destrusor pressure at Qmax was 7.9 cmH2O.
Investigators evaluated treatment efficacy in 206 (63%) of the 327 patients at 10 years. To decrease bladder outlet resistance, medications such as alpha blockers and 5-alpha-reductase inhibitors were used in more than 60% of patients and did not change over time, whereas 31% of men had endoscopic prostate surgery, Seong Jin Jeong, MD, PhD, of Seoul National University Bundang Hospital in South Korea reported. Medication for storage symptoms, such as anticholinergics, beta-3 agonists, and desmopressin, were used in 40% of patients in the first year as well as at 10 years.
Cholinergics were used to treat 10.9% of patients in the first year, but decreased to 5.1% of patients after 10 years. Use of clean intermittent catheterization also decreased. Patients increasingly chose observation without treatment: 4.4% in the first year to 12.1% at 10 years.
This increase “may imply that there is a group who are reconciled to observation without treatment because all the treatment for idiopathic [detrusor underactivity] is ineffective,” the investigators noted in their study abstract.
Despite treatment, lower urinary tract symptoms and voiding efficacy worsened over time. The International Prostate Symptom Score voiding and storage scores increased. Free Qmax decreased from 8.6 to 7.4 mL/s, whereas free post-void residual volume significantly increased from 78.2 to 122.3 mL. In men, bladder contractility index decreased from 77.5 to 61.7, whereas in women, flow and pressure stayed the same.
Idiopathic detrusor underactivity appears to be a disease that progresses slowly and worsens over time, according to Dr Jeong. He noted that fundamental treatment to restore contractile function of detrusor muscle is lacking.
Jeong S, Kim J, Song S, et al. 10-year follow-up observation of idiopathic detrusor underactivity in the elderly living in community: Treatment and urodynamic changes. Presented at ICS 2022; September 7-10, Vienna, Austria. Abstract 160.