The Clinical Significance of the Subtypes of Detrusor Overactivity: A Systematic Review.

Introduction: Detrusor overactivity (DO) is the "occurrence of detrusor contraction(s) during filling cystometry" [7] and can be "phasic" or "terminal" [26]. The aim of this systematic review was to establish whether there is any clinical significance between the different subtypes of DO in terms of demographics, underlying pathophysiology, symptoms, other urodynamic parameters and response to treatment.

Methods: A systematic search was performed using PubMed, Cochrane, MEDLINE, Web of Science and EMBASE databases in February 2024, following the PRISMA guidelines. The Newcastle Ottawa critical appraisal tool was used to assess the risk of bias in the included studies.

Results: The search identified 16 relevant studies including eight prospective and eight retrospective studies. Patients with terminal DO were found to be significantly older (p = 0.0003) and were more likely to have suffered spinal cord trauma (p = 0.04) compared to those with phasic DO. Patients with terminal DO were also found to have higher symptom scores and more likely to also suffer with incontinence than those with phasic DO. Patients with terminal DO were found to have smaller functional capacities than those with phasic DO on urodynamics. Success rates, following trans-urethral resection of the prostate (TURP), were 69.2% for patients with phasic DO and 9.5% for those with terminal DO.

Conclusion: Patients with terminal DO are more likely to be older, suffer with worse symptoms, have smaller bladder capacities and respond less favourably to treatment than those with phasic DO. Future studies incorporating DO should consider analysing these two sub-types of DO as separate clinical entities.