Impaired detrusor contractility in community-dwelling elderly presenting with lower urinary tract symptoms.
OBJECTIVE
To determine the prevalence of impaired detrusor contractility (IDC) with and without detrusor hyperactivity (DH) among community-dwelling elderly with lower urinary tract symptoms and to identify which patients are at a greater risk of having a hypocontractile detrusor.


METHODS
We performed a retrospective chart review of all patients 70 years old or older with storage and/or voiding lower urinary tract symptoms who had undergone urodynamic pressure-flow studies in a urodynamic referral center during a 2-year period.


RESULTS
During the study period, 181 patients (82 men [45%] and 99 women [55%]), aged 70 years or older (mean age 75.7 +/- 4.8), underwent urodynamic studies. IDC was detected in 39 (48%) of the 82 men and in 12 (12%) of the 99 women. Two thirds of the men and one half of the women with IDC also had involuntary detrusor contractions during the filling phase and/or low bladder compliance. The prevalence of IDC/DH-IDC was significantly greater in those with a history of urinary retention and an indwelling urethral catheter.


CONCLUSIONS
Detrusor-impaired contractility is an important pathophysiologic mechanism in older patients with lower urinary tract symptoms, especially in men. Establishing the diagnosis by urodynamic pressure-flow studies is crucial for determining treatment--potentially harmful to this vulnerable population--from objective parameters rather than by empirical decisions.
Abarbanel
Joseph
J
Department of Urology, Rabin Medical Center (Hasharon Hospital), Petach-Tikva, Israel. abar1@zahav.net.il
Marcus
Esther-Lee
EL
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D009119:Muscle Contraction / Q000502:physiology; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000503:physiopathology*; D014555:Urination Disorders / Q000503:physiopathology*; D014563:Urodynamics