Contemporary concepts in the aetiopathogenesis of detrusor underactivity

The aetiology and pathophysiology of detrusor underactivity (DUA) are poorly understood—multiple aetiological factors and pathogenic mechanisms are likely to be involvedDefinite aetiologies include injuries or diseases of the nervous system and diabetes mellitus. Bladder outlet obstruction and normal ageing can, at present, only be considered likely causes of DUAAetiological factors probably cause DUA by interrupting processes that are essential for the generation of an efficient voiding contractionPathophysiological mechanisms can be classified as myogenic (affecting detrusor myocytes or their surrounding matrix) or neurogenic (affecting central neural control mechanisms governing the voiding reflex or afferent and/or efferent nerves)To develop new effective treatments, a better understanding of the mechanism underlying the generation of a normal voiding contraction and which abnormalities cause DUA is required