Reduced/absent bladder sensation

Author: Kevin Rademakers
Last updated: October 2018

Current definitions of Symptoms:

Reduced bladder filling sensation: Complaint that the sensation of bladder filling is less intense or occurs later in filling than previously experienced. (1)

Past definition: When the individual is aware of bladder filling but does not feel a definite desire to void (2)

Absent bladder filling sensation: Complaint of both the absence of the sensation of bladder fullness and a definite desire to void. (1)

Past definition: No sensation of bladder filling and/or desire to void (2,3)

Non-specific (atypical) bladder filling sensation (bladder dysesthesia): Complaint of abnormal bladder filling sensation such as the perception of vague abdominal bloating, vegetative symptoms (nausea, vomiting, faintness) or spasticity. It differs from normal bladder filling sensation or pain, pressure or discomfort of the bladder. (1)

Past definition: the individual report no specific bladder sensation, but may perceive bladder sensation as abdominal fullness, vegetative symptoms or spasticity. (2)

Current definitions of SIGNS:

Normal sensation: The individual is aware of increasing sensation with bladder filling up to a strong desire to void (3).

Reduced bladder sensation: Bladder sensation perceived to be diminished during filling cystometry (3)

Absent bladder sensation: No bladder sensation during filling cystometry, at least to expected capacity of 500mL (3)

Controversies:

  • Reduced and/or absent bladder sensation may be of upmost importance in specific voiding dysfunctions. A recent editorial paper of Chapple and colleagues included reduced bladder sensation in the proposed Underactive Bladder working hypothesis (4).

  • Which tools are useful to determine bladder sensation; can we use urodynamics or only the sensation-related bladder diary (SRBD)? Ideally, non-invasive sensation related bladder diaries (SRBD) should be used (6). However, the disadvantage of an SRBD would be the absence of the urodynamic traces (7). The in-hospital, non-physiological situation and dependence on the urodynamic staff to annotate the different kind of sensations are clear limitations of urodynamic sensory function assessment (8). This could limit the value of using the exact volumes at which different filling sensations are present. Despite the existing limitations, several recent studies confirmed the tolerability, reliability and reproducibility of urodynamic filling sensation (9-11).

  • Studies with regard to bladder sensation have mainly been focused on increased sensation. In contrast, reduced or absent bladder filling sensation is a rather unexplored topic. Therefore, several basic question still remain unanswered, such as:

o ‘What is the clinical importance of absent bladder sensation? And is it related to any potential clinical phenotype?’
o ‘Can we define diminished bladder sensation and give it a value? And if so, do we need additional diagnostic tools to further optimise diagnostic work-up to define patients with a diminished bladder sensation.’
o ‘Is diminished/absent bladder sensation a reversible process? Can we influence bladder sensation and herewith improve voiding function in patients with diminished/absent sensation and deteriorated voiding function?
o These rather basic question will become important with the increasing amount of research in the field of voiding dysfunction. Specifically as there are currently early stage developments in therapeutic compounds for improvement of voiding function (12, 13). With these developments pre- and post-treatment bladder sensation evaluation might also be considered and of equal importance besides the objective improvement in voiding function.

REFERENCES

  1. Haylen B,D’Ancona C,Oelke M, Herschorn S, Abranches-Monteiro L et al. The international continence society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Manuscript to be submitted in 2019.
  2. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-78. PubMed PMID: 11857671. Epub 2002/02/22. eng.
  3. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4-20. PubMed PMID: 19941278. Epub 2009/11/27. eng.
  4. De Wachter SG, Heeringa R, Van Koeveringe GA, Winkens B, Van Kerrebroeck PE, Gillespie JI. "Focused introspection" during naturally increased diuresis: description and repeatability of a method to study bladder sensation non-invasively. Neurourol Urodyn. 2014 Jun;33(5):502-6. PubMed PMID: 23794516.
  5. Smith PP, Chalmers DJ, Feinn RS. Does defective volume sensation contribute to detrusor underactivity? Neurourol Urodyn. 2014:n/a-n/a.
  6. De Wachter S, Wyndaele JJ. Frequency-volume charts: a tool to evaluate bladder sensation. Neurourology and urodynamics. 2003;22(7):638-42. PubMed PMID: 14595606.
  7. De Wachter S, Smith PP, Tannenbaum C, Van Koeveringe G, Drake M, Wyndaele JJ, et al. How should bladder sensation be measured? ICI-RS 2011. Neurourology and urodynamics. 2012 Mar;31(3):370-4. PubMed PMID: 22415808.
  8. Erdem E, Akbay E, Doruk E, Cayan S, Acar D, Ulusoy E. How reliable are bladder perceptions during cystometry? Neurourology and urodynamics. 2004;23(4):306-9; discussion 10. PubMed PMID: 15227645.
  9. Rees DL, Whitfield HN, Islam AK, Doyle PT, Mayo ME, Wickham JE. Urodynamic findings in adult females with frequency and dysuria. Br J Urol. 1975;47(7):853-60. PubMed PMID: 1241333.
  10. Carr LK, Webster GD. Bladder outlet obstruction in women. Urol Clin North Am. 1996 Aug;23(3):385-91. PubMed PMID: 8701553.
  11. Griffiths DJ. The mechanics of the urethra and of micturition. Br J Urol. 1973 Oct;45(5):497-507. PubMed PMID: 4270633.
  12. Matsuya H, Otsuki T, Kida J, Wakamatsu D, Okada H, Sekido N. PD7-01 ONO-8055, A noverland ptent prostanoid EP2 and EP3 receptor dual agonist, improves voiding dysfunction in a monkey underactive bladder model. The Journal of Urology. 2015;193(4):e184-e5.
  13. Chapple C, Bruce M, Ohno T, Kuwayama T, Deacon S. MP21-07 Safety, tolerability and pharmacokinetics of single and multiple ascending doses of the EP2/EP3 receptor agonist ONO-8055, A potential new therapy for underactive bladder, in healthy subjects. The Journal of Urology. 2015;4(193):e235.
Keep me updated