S50 The underactive bladder as a cause for the lower urinary tract symptoms in elderly men Eur Urol Suppl 2013;12;e1158

Halachev N.1, Smilov N.1, Mladenov D.2

1Medical Institute Ministry of Interior, Dept. of Urology, Sofia, Bulgaria, 2University Hospital “Alexandrovska”, Dept. of Urology, Sofia, Bulgaria

INTRODUCTION & OBJECTIVES: The underactive bladder is relatively rare cause for complaints from the lower urinary

tract. The condition is sometimes difficult to treat and the existing pharmacologic and surgical methods are with unsatisfactory

results. That is why part of the patients reaches intermittent or long-term indwelling catheterization.

The aim of the study is to investigate the frequency of the underactive detrusor as an etiological cause for LUTS by men above

50 years of age

MATERIAL & METHODS: During the period April 2012 – June 2013 we performed 69 pressure-flow studies (PFS) in men at

age above 50 with LUTS. We studied the patients with underactive bladder (UAB), defined as a presence of Bladder Contractility

Index (BCI) of less than 100 and accompanied by low-flow micturition with Qmax under 10 ml/sec.

Subject of interest was the incidence and the age distribution of UAB among the investigated patients, the presence of

accompanying subvesical obstruction and/or bladder overactivity, as well as possible prognostic factors – residual urine and

uroflowmetric criteria.

RESULTS: We found out evidence for underactive bladder in 27 (39 %) of the investigated 69 men. The age distribution of the

patients is shown in Table 1.

Table 1: Age distribution of the patients with UAB

Age (years) 50-55 56-60 61-65 66-70 71-75 76-80 Above 80

Number of patients 1 3 1 5 9 6 2

We found out an accompanying bladder outlet obstruction of the lower urinary tract in 12 (44%) patients and overactivity – in 8

(29%) patients.

By the means of uroflowmetry performed upfront we have registered a micturition curve that is typical for hypocontractility in 13

patients, for compressive obstruction in 7 patients and abdominal type of micturition in 5 patients. Two patients could not perform

micturition. The volume of urine requiring voiding under the conditions of uroflowmetry was measured bellow 150 ml in 6

patients, in the range of 150-200 ml in 9 patients, 200-250 ml in 8 patients and above 250 ml in 4 patients. The data for the

measured residual volume are shown in Table 2.

Table 2: Residual urine after free uroflowmetry and PFS

Residual urine ml Below 50 50-100 100-150 Above 150

Patients with Uroflowmetry 4 9 9 5

Patients with PFS (after reaching cyctometric capacity)

0 7 5 15

CONCLUSIONS: 1. In approximately 40% of the elderly men the underactive bladder contributes for LUTS and this

percentage increases above 75 years of age.

2. In some cases the accompanying bladder overactivity and obstruction can mask the bladder weakness, which might lead to

surgical approach with unsatisfactory result.

3. Certain clinical signs (low micturition volumes, weak uroflowmetric curves, residual urine above 100 ml) are associated with

increased probability for impaired bladder contractility. The active search for those signs would improve the management of the

LUTS in elderly men