Detrusor Muscle Hyperactivity Diagnosis and Management

Definition and Terminology

The International Continence Society endorses the term "detrusor overactivity" to describe a urodynamic observation characterized by involuntary detrusor contractions during the bladder filling phase, which may be spontaneous or provoked 1, 2
Detrusor overactivity is a distinct urodynamic finding that requires cystometry to diagnose and documents involuntary bladder contractions during filling, whereas overactive bladder syndrome is a symptom-based clinical diagnosis defined as urgency with or without urgency incontinence, usually accompanied by frequency and nocturia 1, 2

In older men, detrusor overactivity is one component of lower urinary tract symptoms that includes both storage symptoms and voiding symptoms, and may coexist with bladder outlet obstruction from prostatic enlargement 1, 2
In women with urgency incontinence or mixed incontinence, multichannel filling cystometry can identify detrusor overactivity when invasive or irreversible treatments are being considered 3, 4
Women with high-grade pelvic organ prolapse may have occult detrusor overactivity that becomes apparent only when the prolapse is reduced during urodynamic testing 3, 4
In children, detrusor overactivity may coexist with dysfunctional voiding patterns, creating mixed presentations with urgency, urge incontinence, and incomplete bladder emptying 5, 6

Urodynamic studies with multichannel filling cystometry are required to definitively diagnose detrusor overactivity, as this is a urodynamic observation, not merely a symptom 1, 2, 3, 4
When conservative treatments fail and invasive, potentially morbid, or irreversible treatments are considered, urodynamic confirmation becomes important to guide therapy selection 3, 4