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Detrusor Underactivity: The Current Concept of the Pathophysiology
Author(s) -
YOSHIDA Masaki,
YAMAGUCHI Osamu
Publication year - 2014
Publication title -
luts: lower urinary tract symptoms
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.451
H-Index - 15
eISSN - 1757-5672
pISSN - 1757-5664
DOI - 10.1111/luts.12070
Subject(s) - medicine , pathophysiology , detrusor muscle , reflex , urination , efferent , urinary bladder , contractility , afferent , neuroscience , urology , pathology , anesthesia , urinary system , psychology
Based on evidence from available literature, we review the pathophysiology of detrusor underactivity ( DU ). DU is likely to be multifactorial. Aging reduces detrusor activity, but other concomitant causes may aggravate this condition, resulting in decrease of detrusor contractility. Impaired detrusor contractility has been regarded as a major etiologic factor of DU . However, a more complex pathology has been proposed. As contributing factors to DU , we discuss disturbances of the sensory afferent side of the micturition reflex, the central nervous system ( CNS ) and the efferent side of the reflex, including nerves and the detrusor muscle. Particularly, dysfunction of afferent nerves in the bladder and urethra may play a crucial role in the pathogenesis of DU . In addition, recent studies suggest that chronic bladder ischemia and resultant oxidative stress cause detrusor overactivity progressing to DU and inability to empty the bladder.