How to treat SUI in women with Detrusor Underactivity Dmitry - - PowerPoint PPT Presentation

How to treat SUI in women with Detrusor Underactivity

Dmitry Pushkar Moscow, Russia

Dmitry Pushkar

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Detrusor underactivity: definition

Detrusor contraction with

Reduced contraction strength Or duration

Resulting

Prolonged bladder emptying

And/or

Incomplete bladder emptying

Failure to achieve complete bladder emptying within a normal time span

Underactive bladder

• Inability to empty the urinary bladder with voiding
• ICD-9 (zones)
• Incomplete emptying of the bladder
• Accumulation of the urine in the bladder because of inability to urine
• UAB Syndrome
• Bothersome inability to empty the urinary bladder
• Persistent residual urine > 150 ml with bothersome symptoms

Overflow incontinence or/and Stress incontinence

Female voiding patterns

• 1971

New terms

• “Situational inability to void”
• “Situational inability to void as usual”
• Voiding may be influenced by mental state and anxiety in the test

situation for the patient may plausibly influence initiation of the voiding reflex and consequently affect detrusor function.

Bladder contractility nomogram (ICS)

Patients are divided into 3 classes: strong, normal, and weak contractility according to the Bladder Contractility Index (BCI).

Composite nomogram

Categorization of patients into 9 zones based on the BOOI and BCI. Modified from Abrams. BOOI, Bladder Outlet Obstruction Index; BCI, Bladder Contractility Index; Pdet, detrusor pressure; Qmax, maximum flow rate.

24% of young women void 3 times a day or less