Underactive bladder (UAB) is one of the lower urinary tract conditions that commonly affects older adults, but its pathophysiology remains unclear. Animal studies have shown that arterial stiffness affects detrusor underactivity, yet clinical evidence in humans is scarce. Among vascular markers, brachial-ankle pulse wave velocity (baPWV) reflects arterial stiffness, whereas the ankle-brachial index (ABI) indicates arterial narrowing. We therefore examined the association between UAB and these vascular function tests.

92 patients aged ≥40 years who visited both urology and cardiology department between 2022 and 2024 were included in this study. Patients were divided into those without LUTS (non-UAB) and those with UAB, based on the 2018 ICS definition. Patient background, comorbidities, and the presence of arterial stiffness were evaluated using non-invasive vascular assessment. Exclusions were pelvic organ prolapse, urethral stricture, spinal cord disease, neurodegenerative disorders, and acute or severe stroke. Both baPWV (brachial-ankle pulse wave velocity) and ABI were measured to assess vascular status; a prespecified high-risk cutoff for baPWV was ≥1800 cm/s.

86 patients were analyzed (UAB n=24, non-UAB n=62), the mean ages were 80.2 and 75.9 years, respectively (p=0.07). Mean baPWV was higher in UAB than non-UAB patients (2605.5 vs 1855.0 cm/s). In logistic regression, baPWV ≥1800 cm/s was independently associated with UAB (adjusted OR 9.8, 95% CI 1.9–50.7, p<0.01), whereas age, BMI, hypertension, diabetes, dyslipidemia, LSCS, and ABI ≤0.9 were not significant.

These results suggest that, in older women, arterial stiffness is not just a bystander but a potential independent contributor to UAB pathophysiology. The strong association between elevated baPWV and UAB, even after adjustment for age and conventional cardiovascular risk factors, indicates that systemic atherosclerotic change may specifically impair detrusor function rather than simply reflecting overall frailty or aging. The lack of association with ABI supports the notion that diffuse arterial stiffening, rather than focal large-vessel narrowing, is the relevant vascular phenotype in UAB. Taken together, these findings raise the possibility that microvascular compromise due to increased arterial stiffness could underlie detrusor underactivity, and they highlight the need to consider vascular health assessment and possibly early vascular intervention as part of the comprehensive management and prevention strategy for UAB in elderly women.

In women, UAB was independently associated with arterial stiffness, irrespective of age. These findings suggest that systemic atherosclerosis may play an important role in the pathogenesis of UAB.

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Continence 19S (2026) 102688
DOI: 10.1016/j.cont.2026.102688