Diagnosing and Managing Bladder Outlet Obstruction with Detrusor Underactivity in Males

Purpose of Review The goal of this review was to critically appraise the current literature on diagnosing and managing bladder outlet obstruction (BOO) with detrusor underactivity (DU) in males. This review evaluated the diagnostic criteria for these conditions employing both clinical and urodynamic parameters. Current treatment options were also assessed. Recent Findings In recent years, research has concentrated on obtaining secure diagnostic criteria for DU and to distinguish it from BOO. Many recent retrospective papers have reported predictive clinical factors; however, clinical findings are still insufficient. Urodynamics are required. However, the parameters remain not uniformly standardised and include Bladder Contractility Index, Schafer pressure-flow nomogram and Watts Factor, amongst others. Conversely BOO is almost universally diagnosed with a standardised index. Treatment options for DU and BOO include conservative management with clean intermittent self-catheterisation or catheterisation. Pharmaceutical options remain limited. Botulinum toxin urethral sphincter injection and sacral neuromodulation show promise. Surgical options include BOO surgery with significant improvement in physiological parameters and clinical recovery of spontaneous voiding. Newer laser techniques may be superior to traditional surgical options. Summary Recent studies of DU and BOO remain predominantly retrospective, unrandomised and small. Hence, the clinical significance of any findings is quite uncertain. The lack of standardisation in the diagnostic criteria and urodynamic parameters for DU also remains a concern. Meaningful comparison of available treatment options is compromised. Larger prospective randomised studies with diagnostic standardisation are urgently required to allow confidence in evidence-based treatment decisions.