Clinical presentation and underlying pathophysiology of an underactive bladder

Detrusor underactivity (DU) is frequently encountered in elderly patients with chronic medical or neurological diseases. DU causes chronic urinary retention or large postvoid residual urine that is usually difficult to manage. The pathophysiology of DU may involve neurogenic, myogenic, and bladder outlet pathologies. Recent studies also reveal that urothelial dysfunction of the urinary bladder may be associated with impaired bladder sensation as well as impaired detrusor contractility. This article reviews recent research on the prevalence, pathophysiology, and clinical management of DU. Comprehensive clinical investigations and basic research may provide a better understanding and effective treatment for this common but difficult bladder disorder.