Detrusor underactivity (DUA) is one of the etiologic factors of female LUTS, even though no definite standardized urodynamics (UDS) criteria of DUA have been defined in women. Urodynamic evaluation including pressure flow study is invasive-nature and maybe give discomfort for the patients. Therefore, UDS is not a routine method for evaluation of LUTS. Several trial of non-urodynamic diagnosis criteria of DUA has been examined. Recently Japanese continence society has published the non-UDS criteria for DUA (#1). 
 The aim of this study was to investigate the non-urodynamic DUA criteria (JCS DUA criteria) comparing with UDS criteria of DUA and bladder outlet obstruction (BOO).

Female patients with DUA were selected in this retrospective study from our UDS database. The used non-UDS criteria as follows; i) Symptom complex of underactive bladder (in particular, the voiding symptoms of slow stream, hesitancy and straining to void, and often reduces sensation of filling), ii) Qmax<12 and PVR>100ml, iii) BE (Bladder Voiding Efficiency) <90%, iii) Absence of significant pelvic organ prolapse (cystocele with equal to and less than grade II). Exclusion criteria were neurologic disease and other clear BOO condition (urethral stricture etc.). These selected DUA patients were further stratified according to the 4 UDS criteria of DUA: i) Pdet@Qmax≦10 and Qmax≦12(Jeong2012); ii) Pdet@Qmax≦30andQmax≦10(Arbabanel2007); iii) Pdet@Qmax≦20, Qmax≦15, and BE<90%(Gammie2016); iv) PIP1(Pdet@Qmax+Qmax) <30 (Griffiths 2004). To investigate the presence of BOO in these non-UDS criteria, DUA patients were also further stratified according to the 4 UDS criteria of BOO: i) Pdet@Qmax≧21 and Qmax≦11(Lemack 2000); ii) Pdet@Qmax≧40 and Qmax No limit (Kuo2005); iii) Pdet@Qmax>2xQmax (Solomon 2014); iv) Pdet@Qmax≧40, Qmax<12, and BE≧90% (Gammie 2016). The result of non-UDS diagnosis for DUA was compared with the result of UDS diagnosis for DUA and BOO.

Only 16 patients (mean age 69.8±10.7) were selected using non-UDS DUA criteria from our UDS database(N=803). In 16 patients, 43% of detrusor overactivity were found. Prevalences of UDA were low (30-38%) except using Jeong criteria (0%) according to 4 UDS criteria (Table 1). Twenty-five to 88% of BOO patients were found except Gammie criteria (0%) according to the UDS BOO criteria (Table 2). These results may suggest  that Non-UDS criteria diagnosis for DUA may include BOO and other conditions.

Clinical diagnostic criteria (Non-urodynamic criteria) may be clinically suitable because of no discomfort and not invasive. However, its accuracy for DUA diagnosis may be unsure. On the other point, no established urodynamic criteria for DUA are also an urgent issue. To facilitate the research for DUA, UDS criteria for DUA should be established. This study is exceedingly small and has limitation. More large study is necessary to confirm these results.

Non-UDS criteria for female detrusor underactivity may have weak power to discriminate DUA and BOO. Non-UDS criteria for DUA diagnosis should be carefully used for its accuracy. We may need more refined non-UDS criteria for female UDA.

Yoshida M, et.al:Clinical diagnostic criteria for detrusro underactivity: A report from the Japanesse Contiennce Society working group on underactive bladderLUTS 2020;1-4