The European Association of Urology (EAU) Guidelines Panel on non-neurogenic male lower urinary tract symptoms (LUTS) aimed to develop a new subchapter on underactive bladder (UAB) in non-neurogenic men to inform health care providers of current best evidence and practice. Here, we present a summary of the UAB subchapter that is incorporated into the 2024 version of the EAU guidelines on non-neurogenic male LUTS.
A systematic literature search was conducted from 2002 to 2022, and articles with the highest certainty evidence were selected. A strength rating has been provided for each recommendation according to the EAU Guideline Office methodology.
Detrusor underactivity (DU) is a urodynamic diagnosis defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span. UAB is a terminology that should be reserved for describing symptoms and clinical features related to DU. Invasive urodynamics is the only widely accepted method for diagnosing DU. In patients with persistently elevated postvoid residual (ie, >300 ml), intermittent catheterization is indicated and preferred to indwelling catheters. Alpha-adrenergic blockers are recommended before more invasive techniques, but the level of evidence is low. In men with DU and concomitant benign prostatic obstruction (BPO), benign prostatic surgery should be considered only after appropriate counseling. In men with DU and no BPO, a test phase of sacral neuromodulation may be considered.
The current text represents a summary of the new subchapter on UAB. For more detailed information, refer to the full-text version available on the EAU website (https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts).
The European Association of Urology guidelines on underactive bladder in non-neurogenic adult men are presented here. Patients must be fully informed of all relevant options and, together with their treating physicians, decide on the most optimal management for them.
European urology. 2024 Apr 20 [Epub ahead of print]
Michael Baboudjian, Hashim Hashim, Nikita Bhatt, Massimiliano Creta, Cosimo De Nunzio, Mauro Gacci, Thomas Herrmann, Markos Karavitakis, Sachin Malde, Lisa Moris, Christopher Netsch, Malte Rieken, Vasileios Sakalis, Natasha Schouten, Manuela Tutolo, Jean-Nicolas Cornu
Department of Urology, APHM, North Academic Hospital, Marseille, France; Department of Urology, APHM, La Conception Hospital, Marseille, France; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Urology, La Croix, Quint Fonsegrives, France. Electronic address: ., Bristol Urological Institute, Bristol, UK., Department of Urology, East of England Deanery, Cambridge, UK., Urology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy., Department of Urology, Sapienza University, Ospedale Sant'Andrea, Rome, Italy., Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Department of Urology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland., Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece., Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium., Asklepios Klinik Barmbek, Hamburg, Germany., University of Basel, Basel, Switzerland., Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece., European Association of Urology Guidelines Office, Arnhem, The Netherlands., Department of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France.