The presentation is aimed at sensitizing clinicians for often ignored pathology and sharing current literature with inclusion of Natural history, patient counselling and approach to select the appropriate treatment along with a follow up plan.

Literature Review including related texts, Original  researches and review articles.

Detrusor Underactivity (DU) is defined by International Continence Society as a Clinical condition  characterized by “low detrusor pressure or short detrusor contraction time, usually in combination with a low urine flow rate resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span measured by urodynamics” and the term UAB is reserved for “symptom complex”.

In DU, symptoms may vary from Voiding LUTS to Storage symptoms. There may even be an overlap of symptoms between DU, OAB and BOO. Currently Urodynamic Study suggesting weak detrusor strength(Bladder Contractility Index -BCI) is the standard investigation to diagnose DU and most reliably differentiate between the three.

It is evident with ongoing researches that there are more ‘Druggable Targets’ to be explored 

The management of DU should aim at relieving symptoms, preventing complications and improving or maintaining QoL. This include conservative to complex reconstructive surgeries(LDDM, RADM). The  available options  be offered as “Tailored Care model” and not as “Algorithmic Flow.

Higher level of evidence needs to be generated for interventions like ‘Neuromodulation, Regenerative and Stem Cell Therapies’. In the current scenario, patient adherence to treatment plan, solely depends on the information furnished as gathered through available research data. And the recommendations here are weak frequently ill-defined with not only sparse data but mostly with low level of evidence. Therefore, an effective approach in  managing DU patients crucially relies on understanding the disease, defining patient symptoms as precisely as possible to select together with the patient the most appropriate therapy.

1.	DU is defined as a Clinical condition characterized by prolonged emptying and/or failure to achieve complete emptying within a normal time span and the term Underactive Bladder (UAB) is reserved for “symptom complex”.

2.	Detrusor Contractility has traditionally been considered as predominant etiologic factor in Detrusor Under activity but  research and literature have established that Detrusor Under Activity has multi factorial basis. 
3.	It can be Primary /Idiopathic most typically identified in aging men and, Secondary including  Iatrogenic origin. 
4.	Currently Urodynamic Study suggesting weak detrusor strength(Bladder Contractility Index -BCI) is the standard investigation to diagnose DU that also most reliably differentiate between DU, OAB and BOO.
5.	Despite being attractive with non-invasive nature of tests, the diagnostic role of Urine Biomarkers have yet not been established for DU. 
6.	The wide range of treatment options available, should be offered as “Tailored Care model” and not as “Algorithmic Flow” with guiding principle “As effective as needed and as non-invasive as possible”.