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      How do we diagnose detrusor underactivity? Comparison of diagnostic criteria based on an urodynamic measure

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          To compare several contemporary urodynamic criteria for diagnosing detrusor underactivity (DU) and estimate how well they coincide with each other.

          Materials and Methods

          From our prospective urodynamic database we identified nonneurogenic lower urinary tract symptoms (LUTS) patients older than 60 years between 2003 and 2014. Patients were reclassified based on four and three contemporary criteria for DU among men and women. Each criterion was compared with the others using the McNemar test.


          Urodynamic data of 4,372 patients (3,357 men and 1,015 women) were analyzed. In men, the prevalence of DU was estimated to be 56%, 17%, 5%, and 10% based on bladder contractility index, Abrams-Griffith number, maximal detrusor pressure at maximal flow rate (PdetQmax) 30, and bladder voiding efficiency (BVE) criteria. In women, 14.9%, 9.6%, and 6.4% of patients were classified as having DU based on maximal flow rate/postvoid residual (Qmax/PVR), PdetQmax 30, and BVE criteria. For individual subjects, all 4 criteria for men were significantly different from each other, while PdetQmax 30 and BVE criteria for women did not differ significantly (p=0.065). Additionally, BVE criterion for men and PdetQmax 30 and BVE criteria for women could distinguish the differences of patient age, free Qmax and free PVR between patient with and without DU.


          Each urodynamic criterion for men does not coincide with each other in the diagnosis of DU within individual subjects. On the other hand, PdetQmax 30 criteria and BVE criteria for women could be appropriately applied to clinical practice when diagnosing DU in women with LUTS.

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          Most cited references 12

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          The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society.

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            Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies.

            This is the first report of the International Continence Society (ICS) on the development of comprehensive guidelines for Good Urodynamic Practice for the measurement, quality control, and documentation of urodynamic investigations in both clinical and research environments. This report focuses on the most common urodynamics examinations; uroflowmetry, pressure recording during filling cystometry, and combined pressure-flow studies. The basic aspects of good urodynamic practice are discussed and a strategy for urodynamic measurement, equipment set-up and configuration, signal testing, plausibility controls, pattern recognition, and artifact correction are proposed. The problems of data analysis are mentioned only when they are relevant in the judgment of data quality. In general, recommendations are made for one specific technique. This does not imply that this technique is the only one possible. Rather, it means that this technique is well-established, and gives good results when used with the suggested standards of good urodynamic practice. Copyright 2002 Wiley-Liss, Inc.
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              Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function.

               Murray Abrams (1999)

                Author and article information

                Investig Clin Urol
                Investig Clin Urol
                Investigative and Clinical Urology
                The Korean Urological Association
                July 2017
                27 June 2017
                : 58
                : 4
                : 247-254
                [1 ]Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
                [2 ]Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
                [3 ]Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
                [4 ]Department of Urology, Seoul National University Hospital, Seoul, Korea.
                Author notes
                Corresponding Author: Seung-June Oh. Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. TEL: +82-2-2072-2406, FAX: +82-2-742-4665, sjo@
                © The Korean Urological Association, 2017

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Original Article
                Lower Urinary Tract Dysfunction

                detrusor underactivity, diagnosis, urodynamics


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