UROLOGY - ORIGINAL PAPER Defining and advancing education and conservative therapies of underactive bladder Tomas L. Griebling • Catherine E. DuBeau • George Kuchel • Mary H. Wilde • Michelle Lajiness • Hikaru Tomoe • Ananias Diokno • Andrew Vereecke • Michael B. Chancellor Received: 7 July 2014 / Accepted: 21 July 2014 Ó Springer Science+Business Media Dordrecht 2014 Abstract In contrast to other forms of voiding dysfunc- tion, underactive bladder (UAB) has traditionally received little research or educational attention. This is changing as our understanding of the underlying mechanisms of detrusor dysfunction and other forms of underactive blad- der improves. In addition, the impact of UAB on patient symptoms, general and health-related quality of life, and caregiver burden are becoming more recognized. However, there remains a paucity of data on the subject, and an extensive need for additional research and education on the topic. This paper explores the current state of knowledge about UAB with an emphasis on education regarding the condition and conservative methods of assessment and treatment. Recommendations for future work in this area are considered. Keywords Underactive bladder Á Aging Á Geriatrics Á Elderly Á Urinary retention Introduction Underactive bladder (UAB) is a term that is currently un- derutilized clinically due to a paucity of research, a lack of standardization of terminology, no current consensus on diagnostic criteria, a lack of awareness, and no known treatment to reverse the condition. The International Con- tinence Society (ICS) currently defines ‘Detrusor Under- activity’ as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete emptying within a normal time span [1]. Their committee on the standardization of ter- minology has not yet used or defined the term ‘Underactive Bladder.’ Potential definitions of UAB are discussed in the paper by DuBeau and associates. Yet, despite its limited clinical recognition, the breadth of the effect of UAB should not be underestimated. Many clinicians and researchers have examined the relationship between aging and the detrusor; however, the precise pathophysiology of the underactive detrusor remains unclear. Aging itself is associated with several changes to the lower urinary tract. The maximum con- tractility of the bladder has been shown to decrease with increasing age, though the pathophysiology of these changes is unclear. Both the detrusor muscle itself and innervation to the bladder have been implicated in UAB. The prevalence of impaired bladder emptying is associated with increasing age and occurs in both men and women [2]. This is manifested in the frequent finding of an elevated postvoid residual urinary volume in an otherwise asymp- tomatic older adult and in association with other lower T. L. Griebling University of Kansas School of Medicine, Kansas City, KS, USA C. E. DuBeau University of Massachusetts Medical Center, Worcester, MA, USA G. Kuchel UConn Center on Aging, University of Connecticut Health Center, Farmington, CT, USA M. H. Wilde School of Nursing, University of Rochester, Rochester, NY, USA M. Lajiness Á A. Diokno Á A. Vereecke Á M. B. Chancellor (&) Beaumont Health System, Royal Oak, MI, USA e-mail: chancellormb@gmail.com H. Tomoe Tokyo Women’s Medical University, Tokyo, Japan 123 Int Urol Nephrol (2014) 46 (Suppl 1):S29–S34 DOI 10.1007/s11255-014-0799-6