PTU - Polskie Towarzystwo Urologiczne
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Impact of bladder outlet obstruction and patients' age on detrusor contractility dysfunction
Article published in Urologia Polska 2005/58/1.


Cezary Szcześniak, Maciej Zbrzeźniak, Andrzej Borówka
Klinika Urologii Centrum Medycznego Kształcenia Podyplomowego w Warszawie
Kierownik kliniki: prof. dr hab. Andrzej Borówka


prostate, benign prostatic hyperplasia, detrusor underactivity


introduction and aim of the study
BPH-related symptoms (LUTS - lower urinary tract symptoms) are well-defined, but their presence is not always associated with bladder outlet obstruction, secondary to adenoma enlargement. Underactivity of bladder detrusor muscle (DU - detrusor underactivity) may play an important role in the development of symptoms. Impaired function of the detrusor manifested as its decreased contractility may have several underlying causes. The objective of this article is to present and discuss their links with DU.
material and method
The paper presents a hypothesis concerning DU development. DU can be a consequence of both urine flow obstruction and degenerative changes in the detrusor dependent on aging. Multiple changes in the bladder wall, involving tissue reconstruction, enzymatic function, neuro-muscular conductivity and blood supply, may lead to detrusor contractility dysfunction. The symptoms that develop are secondary to increasing post-voiding residual volume and bladder overactivity.
DU, which may have several underlying causes, occurs in a significant number of LUTS patients and impacts the outcome of surgical treatment of BPH. DU development is considered to be secondary to bladder outlet obstruction or a result of the aging process. Both processes may coexist, each to different extents. In BPH patients undergoing surgery, DU is an important prognostic factor for treatment outcome. Therefore, this pathology should be diagnosed prior to operation.
The knowledge of all possible causes that result in lower urinary tract dysfunction leads to better understanding of symptoms development, enables improved diagnosis and more effective treatment of LUTS patients.


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Maciej Zbrzeźniak
Klinika Urologii CMKP
00-416 Warszawa
ul. Czerniakowska 231