How to cite: Nettey, Oluwarotimi S. “Open Sesame: Updates in the Management of the Underactive Bladder.” September 19th, 2025. Accessed Dec 2025. https://grandroundsinurology.com/open-sesame-updates-in-the-management-of-the-underactive-bladder/
Oluwarotimi S. Nettey, MD, MHS, Assistant Professor of Urology, Baylor College of Medicine, Houston, Texas, discusses underactive bladder (UAB), emphasizing its diagnostic ambiguity and therapeutic limitations. She notes that detrusor underactivity (DUA) affects up to half of men and women presenting with non-neurogenic lower urinary tract symptoms and is characterized by reduced detrusor contractility, prolonged emptying time, and elevated post-void residual volume. Urodynamic testing remains the gold standard for diagnosis, though it is often costly and limited in availability.
Dr. Nettey differentiates DUA from bladder outlet obstruction, explaining that overlap is common in men due to benign prostatic enlargement. Management centers on symptom relief and renal protection rather than curative therapy. Clean intermittent catheterization or suprapubic diversion may be used for those with significant retention or infection risk.
Treatment for DUA includes pelvic floor therapy and, for women, urethral sphincter botulinum toxin injections or transurethral bladder neck incisions. For men, holmium laser enucleation of the prostate (HoLEP) demonstrates superior catheter-free rates compared with transurethral resection or vaporization techniques, even in hypocontractile bladders. Dr. Nettey highlights sacral neuromodulation as a key therapy, reporting 47 to 90 percent response rates and durable catheter-free outcomes.
Dr. Nettey highlights the future efforts in treating DUA, including extracorporeal shockwave therapy, regenerative stem cell trials, and novel agents targeting neuronal signaling.
About The 29th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Nettey presented this talk at the 2025 conference.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Dr. Oluwarotimi Nettey is an assistant professor at Scott Department of Urology, Baylor College of Medicine. She graduated from Harvard University with a degree in biomedical engineering and attended Yale University School of Medicine where she was awarded a Howard Hughes Medical Institute Research Fellowship. She completed her urology residency at Northwestern University with a Certificate in Global Health and fellowship training in the Division of Female Pelvic Medicine and Reconstructive Surgery at the department of urology at UCLA Medical Center under the leadership of Dr. Victor Nitti.
