Urinary Biomarkers of Detrusor Underactivity

Detrusor underactivity (DU) is a urodynamic diagnosis, often related with the multifactorial symptom complex designated as underactive bladder (UAB), resulting in prolonged and/or incomplete bladder emptying, and many times with a high postvoid residual. DU is a largely under-researched topic and constitutes a multifactorial condition, with several underlying pathophysiological mechanisms, which can be categorized as idiopathic, neurogenic, myogenic, or functional. The main etiological factors of DU are aging, diabetes mellitus, neurogenic disorders, and bladder outlet obstruction (BOO). Biomarkers constitute objectively measurable characteristics that can be evaluated as indicators of physiological and pathogenic processes and might be used as diagnostic, prognostic, or predictive tools in clinical care. Herein, we review up-to-date knowledge of urinary biomarkers of DU.

Several urinary biomarkers, including neurotrophins (NGF and BDNF), markers of oxidative stress, prostaglandins, inflammatory cytokines, ATP/NO, and miRNA, have recently been studied in relation to DU, providing potential insights into the pathophysiology and possible therapeutic targets for this condition.

In DU, biomarkers could allow for early DU diagnosis and monitoring, also granting a larger potential for therapies to halt or revert pathologic changes, such as afferent neurogenic dysfunction, neuroinflammation, denervation and fibrosis of detrusor muscle, and myogenic failure.