Kevin Rademakers

Detrusor underactivity: Pathophysiological considerations, models and proposals for future research. ICI-RS 2013

Detrusor underactivity, resulting in either prolonged or inefficient voiding, is a common clinical problem for which treatment options are currently limited. The aim of this report is to summarize current understanding of the clinical observation and its underlying pathophysiological entities.

Unravelling detrusor underactivity: Development of a bladder outlet resistance-bladder contractility nomogram for adult male patients with lower urinary tract symptoms.

Voiding dysfunction in adult men may be caused by bladder outlet obstruction (BOO) and/or detrusor underactivity (DU). Until now, it is only possible to classify BOO and DU by pressure‐flow analysis. Low values of the maximum Watts factor (Wmax) indicate DU but thresholds for the diagnosis have not been established. Purpose of this study was to construct a nomogram using bladder outlet resistance and detrusor contractility in order to classify BOO and DU simultaneously.

Evaluation of obstructed voiding in the female: how close are we to a definition?

Purpose of review The difficulties of defining and evaluating bladder outlet obstruction (BOO) in the female patient have been described for several years. This review aims to examine recent literature to summarize progress in the area. Recent findings Within the last 2 years, functional causes of female BOO have been summarized, new nomograms proposed, several case reports of different causes of BOO have been published and work on surgical outcomes and possible diagnostics reported. Summary Women complain of voiding dysfunction because of different reasons. For clinical decision-making, and to evaluate different surgical procedures, finding a way of detecting and quantifying infravesical obstruction is immensely helpful. This review aims to clarify questions concerning definitions of BOO in women and provide an update on recent advances.

Latissimus Dorsi Detrusor Myoplasty to Restore Voiding in Patients with an Acontractile Bladder – Fact or Fiction?

Multiple causes at any level between the brain and the bladder can lead to diminished voiding efficiency and bladder acontractility. Treatment options for patients with an acontractile bladder have been limited as most patients were forced to perform lifelong self-catheterization at the moment. The latissimus dorsi detrusor myoplasty (LDDM) is a recent and promising therapeutic surgical option to restore adequate bladder emptying on demand. This article critically reviews the available literature on LDDM and focuses particularly on the preoperative diagnostic evaluation and patient selection, treatment outcome and the postoperative contractility measurement.

Recommendations for future development of contractility and obstruction nomograms for women. ICI-RS 2014.

At present, existing bladder outlet obstruction (BOO) nomograms for women are still not universally accepted. Moreover, only limited information is available regarding bladder contractility in women. The aim is to present the discussions and recommendations from the think tank session “Can we construct and validate contractility and obstruction nomograms for women?” held at the 2014 International Consultation on Incontinence‐Research Society (ICI‐RS) meeting in Bristol, UK.

Differentiation of lower urinary tract dysfunctions: The role of ambulatory urodynamic monitoring

To determine the value of ambulatory urodynamic monitoring in the assessment of patients with lower urinary tract symptoms.

Prediction of sacral neuromodulation treatment success in men with impaired bladder emptying-time for a new diagnostic approach.

Detrusor underactivity (DU) is currently a topic that receives major attention within functional urology. Urologists are often confronted with men who present with voiding dysfunction without bladder outlet obstruction (BOO) or after desobstructive or neuromodulation treatment. Their impaired bladder emptying is suspected to be related to failure of detrusor contractile function. Earlier research indicated that patients with non‐obstructive urinary retention (NOR), for example, detrusor underactivity (DU), have a lower success rate after sacral neuromodulation (SNM) compared to patients treated with SNM for storage dysfunction. However, predicting factors for treatment success in the NOR group have not yet been defined.

Can we define and characterize the aging lower urinary tract? : ICI-RS 2015

The prevalence of lower urinary tract (LUT) symptoms increases with age but the etiology is unknown. This article aims to identify research directions that clarify the basis of this association. The initial question is whether biological age is the variable of interest or a time‐dependent accumulation of factors that impact on LUT function at rates that differ between individuals. In particular, the accumulation of conditions or agents due to inflammatory states or tissue ischemia is important. Much of the above has been concerned with changes to bladder function and morphology. However, the outflow tract function is also affected, in particular changes to the function of external sphincter skeletal muscle and associated sacral motor nerve control. Nocturia is a cardinal symptom of LUT dysfunction and is more prevalent with aging. Urine production is determined by diurnal changes to the production of certain hormones as well as arterial blood pressure and such diurnal rhythms are blunted in subjects with nocturia, but the causal links remain to be elucidated. Changes to the central nervous control of LUT function with age are also increasingly recognized, whether in mid‐brain/brainstem regions that directly affect LUT function or in higher centers that determine psycho‐social and emotional factors impinging on the LUT. In particular, the linkage between increasing white matter hyperintensities and LUT dysfunction during aging is recognized but not understood. Overall, a more rational approach is being developed to link LUT dysfunction with factors that accumulate with age, however, the precise causal pathways remain to be characterized. Neurourol. Urodynam. 36:854–858, 2017.

Associations of Psychometric Affective Parameters with Urodynamic Investigation for Urinary Frequency.

To assess an association between affective symptoms and conventional urodynamic results in a pilot study.

Do we understand voiding dysfunction in women? Current understanding and future perspectives: ICI-RS 2017

Urinary retention in women is poorly understood, compared to the equivalent condition in men, and was the subject of a dedicated session organized at the International Consultation on Incontinence Research Society (ICI‐RS) in Bristol, United Kingdom, 2017.